Provider Demographics
NPI:1932176856
Name:SNIDER, GARY B (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:SNIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 RIVERVIEW AVE
Mailing Address - Street 2:STE 810
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9150
Mailing Address - Fax:757-510-9274
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:STE 810
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9150
Practice Address - Fax:757-510-9274
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005825652Medicaid
VA005825652Medicaid
C36685Medicare UPIN