Glenn Russell Snider Jr., M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

12747 Issued in WV

Practice address

1 Medical Center Drive
Mail Stop 11
Clarksburg, WV 26301

Phone

(304) 623-7606

Fax

(304) 626-7026

NPI assigned

Mar 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861453136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 80",
            "address_2": "LAKE FLOYD",
            "city": "BRISTOL",
            "state": "WV",
            "postal_code": "263329313",
            "telephone_number": "304-623-3461",
            "fax_number": "304-626-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DRIVE",
            "address_2": "MAIL STOP 11",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "26301",
            "telephone_number": "304-623-7606",
            "fax_number": "304-626-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNIDER",
        "first_name": "GLENN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WV",
            "license": "12747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Lynn Smith, MS RD LD
• Tammy Smith
• Timothy Ray Smith
• Tina Michelle Smith
• Tabatha A Smothers
• Jamie Sue Snider, RN
• Katie Snider
• Jaclyn Snyder, LPN
• Riley Snyder
• Richard Howard Southall, LPC

• Geriatric Medicine (Internal Medicine) Physician in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Geriatric Medicine (Internal Medicine) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.