G Gordon Snyder III, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

15262 Issued in CT

Practice address

701 Cottage Grove Rd
A-230
Bloomfield, CT 06002-3080

Phone

(860) 242-5274

Fax

(860) 242-3643

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1720189509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "address_2": "A-230",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-242-5274",
            "fax_number": "860-242-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "address_2": "A-230",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-242-5274",
            "fax_number": "860-242-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNYDER",
        "first_name": "G",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CT",
            "license": "15262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001152628",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "040000101",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• Otolaryngology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.