Provider Demographics
NPI:1205899317
Name:SNYDER, IRVIN J (DO)
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:J
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 61
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-9710
Mailing Address - Country:US
Mailing Address - Phone:304-372-7617
Mailing Address - Fax:304-372-7619
Practice Address - Street 1:RR 1 BOX 61
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9710
Practice Address - Country:US
Practice Address - Phone:304-372-7617
Practice Address - Fax:304-372-7619
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110235672Medicare PIN
WVG09742Medicare UPIN
WVSN0788337Medicare PIN