Provider Demographics
NPI:1295729598
Name:SNYDER, RANDALL W III (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:W
Last Name:SNYDER
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOC, PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0504
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5 SOUTH JERSEY RADIOLOGY ASSOCIATES
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-05-29
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA072479002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2608882OtherAETNA
NJ8534101Medicaid
SN1324758OtherHIGHMARK PA BLUE SHIELD
A3738029OtherOXFORD HEALTH
1142152OtherHORIZON NJ HEALTH
2027651OtherUNITED HEALTHCARE
2017434000OtherAMERIHEALTH
300121123OtherRAILROAD MEDICARE
SN1324758OtherPREMIER BLUE
2027651OtherUNITED HEALTHCARE
NJ048908A2DMedicare PIN