Basic Information
Provider Information
NPI: 1982766572
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNYDER
FirstName: MARK
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Address2: KAISER PERMANENTE MID ATL PERM MED GRP PC ATTN T BROOKS
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 2101 EAST JEFFERSON STREET
Address2:  
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018166425
FaxNumber: 3018167115
Other Information
ProviderEnumerationDate: 12/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD27890MDX Allopathic & Osteopathic PhysiciansInternal Medicine 
207RI0200XD27890MDX Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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