Provider Demographics
NPI:1750387718
Name:SNYDER, DAVID LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:SNYDER
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 1:108 RAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2628
Mailing Address - Country:US
Mailing Address - Phone:856-296-9407
Mailing Address - Fax:856-727-9337
Practice Address - Street 1:108 RAMBLEWOOD RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2628
Practice Address - Country:US
Practice Address - Phone:856-296-9407
Practice Address - Fax:856-727-9337
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025294E2084P0800X
NJMA044031002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008557910004Medicaid
PA818301OtherHEALTHPASS #
NJ001665185OtherBC-PERSONAL CHOICE #
PA353678OtherBLUE SHIELD #
PA1314367OtherFIRST HEALTH #
NJ260035938OtherRAILROAD/FEDERAL #
NJ7268301Medicaid
NJ260035938OtherRAILROAD/FEDERAL #
NJSN951029Medicare ID - Type Unspecified
PA0008557910004Medicaid