Provider Demographics
NPI:1255359220
Name:SNIDER, GREGORY T (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:SNIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 FIELDSTONE WAY
Mailing Address - Street 2:STE. 500
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-9006
Mailing Address - Country:US
Mailing Address - Phone:859-258-8530
Mailing Address - Fax:859-258-8515
Practice Address - Street 1:3061 FIELDSTONE WAY
Practice Address - Street 2:STE. 500
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-9006
Practice Address - Country:US
Practice Address - Phone:859-258-8530
Practice Address - Fax:859-258-8515
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY64001977Medicaid
KY4000501OtherMEDICARE LAB GROUP
KY64001977Medicaid
E43812Medicare UPIN