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General NPI Number Information
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NPI Number | 1912413659
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Entity Type | Organization
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Legal Business Name | SYNERGY SPINE AND PAIN CENTER, LLC
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 09/07/2020
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Provider Practice Location Address
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Address Line | 12150 ANNAPOLIS RD STE 209
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City | GLENN DALE
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State | MD
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Zip | 20769
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Country | US
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Telephone | 413-798-0399
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Fax |
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Provider Business Mailing Address
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Address Line | 12150 ANNAPOLIS RD STE 209
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City | GLENN DALE
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State | MD
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Zip | 20769-9183
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MADHAVI CHADA
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Credential | MD
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Telephone | 240-929-6652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | D76707
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License Number State | MD
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