Provider Demographics
NPI:1528357779
Name:SYNERGY WOMEN'S HEALTH CARE, LLC
Entity Type:Organization
Organization Name:SYNERGY WOMEN'S HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-227-4050
Mailing Address - Street 1:2250 NW FLANDERS STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5410
Mailing Address - Country:US
Mailing Address - Phone:503-702-0159
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5410
Practice Address - Country:US
Practice Address - Phone:503-702-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17854207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150667Medicaid
OR058185Medicaid
112520Medicare UPIN
ORR100998Medicare PIN
OR150667Medicaid