Healthcare Provider Details

I. General information

NPI: 1124941042
Provider Name (Legal Business Name): SYNERGY MEDICAL GROUP IM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 11
TIMONIUM MD
21093-6211
US

IV. Provider business mailing address

1205 YORK RD STE 11
TIMONIUM MD
21093-6211
US

V. Phone/Fax

Practice location:
  • Phone: 443-325-0031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VALENCIA CARSON
Title or Position: PROVIDER ENROLLMENT LEAD
Credential:
Phone: 410-870-9380