Provider Demographics
NPI:1366762692
Name:CHARLES R SNYDER MD PA
Entity type:Organization
Organization Name:CHARLES R SNYDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-731-7830
Mailing Address - Street 1:4131 UNIVERSITY BLVD S
Mailing Address - Street 2:BUILDING 13
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4346
Mailing Address - Country:US
Mailing Address - Phone:904-731-7830
Mailing Address - Fax:904-731-7832
Practice Address - Street 1:4131 UNIVERSITY BLVD S
Practice Address - Street 2:BUILDING 13
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4346
Practice Address - Country:US
Practice Address - Phone:904-731-7830
Practice Address - Fax:904-731-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 15492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61907Medicare UPIN