Healthcare Provider Details

I. General information

NPI: 1912413659
Provider Name (Legal Business Name): SYNERGY SPINE AND PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 209
GLENN DALE MD
20769
US

IV. Provider business mailing address

12150 ANNAPOLIS RD STE 209
GLENN DALE MD
20769-9183
US

V. Phone/Fax

Practice location:
  • Phone: 413-798-0399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD76707
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. MADHAVI CHADA
Title or Position: OWNER
Credential: MD
Phone: 240-929-6652