Healthcare Provider Details
I. General information
NPI: 1740168533
Provider Name (Legal Business Name): SYNTRILLO HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/21/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
240 W MAIN ST STE 100CW113
CHARLOTTESVILLE VA
22902-5005
US
IV. Provider business mailing address
240 W MAIN ST STE 100CW113
CHARLOTTESVILLE VA
22902-5005
US
V. Phone/Fax
- Phone: 434-202-3450
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084N0400X |
| Taxonomy | Neurology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XN1300X |
| Taxonomy | Neurorehabilitation Occupational Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARK
M
MCDONALD
Title or Position: PRESIDENT
Credential: MD
Phone: 770-301-2069