Provider Demographics
NPI:1548288749
Name:SNYDER, MARTIN J (DPM)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 PITTSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-4110
Mailing Address - Country:US
Mailing Address - Phone:570-343-1842
Mailing Address - Fax:570-343-3597
Practice Address - Street 1:1003 PITTSTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-4110
Practice Address - Country:US
Practice Address - Phone:570-343-1842
Practice Address - Fax:570-343-3597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002113L213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA140006787300001Medicaid
PA232318083OtherWC
PA232318083OtherWC
PA140006787300001Medicaid