Provider Demographics
NPI:1174583959
Name:SNYDER, KEVIN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
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 1:1306 LUNDY LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6357
Mailing Address - Country:US
Mailing Address - Phone:410-879-5335
Mailing Address - Fax:
Practice Address - Street 1:754 N HICKORY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3042
Practice Address - Country:US
Practice Address - Phone:410-638-0770
Practice Address - Fax:410-836-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD74738Medicare UPIN
MD8069-KLMedicare ID - Type Unspecified