Basic Information
| Provider Information | |||||||||
| NPI: | 1881648400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNIDER | ||||||||
| FirstName: | DARLENE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 GROSS ST | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405685612 | ||||||||
| FaxNumber: | 7405685668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PS0010X | 34.003945 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000539804 | 01 | OH | ANTHEM | OTHER | 000000696935 | 01 | OH | ANTHEM | OTHER | P00703835 | 01 | OH | RRMCR | OTHER | 0609738 | 05 | OH | MEDICAID | 3810005488 | 05 | WV | MEDICAID |