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General NPI Number Information
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NPI Number | 1558006957
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Entity Type | Organization
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Legal Business Name | SYNERGY REVITALIZE MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5457 TWIN KNOLLS RD STE 300-S6
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City | COLUMBIA
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State | MD
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Zip | 21045-3259
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Country | US
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Telephone | 301-602-4658
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Fax | 301-500-3114
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Provider Business Mailing Address
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Address Line | 5457 TWIN KNOLLS RD STE 300-S11
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City | COLUMBIA
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State | MD
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Zip | 21045-3259
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Country | US
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Telephone | 301-602-4658
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Fax |
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Authorized Official
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Title or Position | PRIMARY CARE PROVIDER
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Name | DR. ELAINE M TAYLOR
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Credential |
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Telephone | 301-602-4658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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