Healthcare Provider Details

I. General information

NPI: 1194029272
Provider Name (Legal Business Name): SYNDOLOR MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 E MARKET ST
WARREN OH
44483-6616
US

IV. Provider business mailing address

1806 E MARKET ST
WARREN OH
44483-6616
US

V. Phone/Fax

Practice location:
  • Phone: 330-469-9175
  • Fax:
Mailing address:
  • Phone: 330-469-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY TELSHAW
Title or Position: BILLING
Credential:
Phone: 330-469-9175