Provider Demographics
NPI:1376005926
Name:SNAJDAR, ELIZABETH B (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:SNAJDAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-3570
Mailing Address - Country:US
Mailing Address - Phone:937-578-2626
Mailing Address - Fax:
Practice Address - Street 1:500 LONDON AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-3570
Practice Address - Country:US
Practice Address - Phone:937-578-2626
Practice Address - Fax:937-578-2627
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016992208800000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208800000XAllopathic & Osteopathic PhysiciansUrology