Provider Demographics
NPI:1629464359
Name:DURAN, MARCELO
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:DURAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 KATY HOCKLEY CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-7838
Mailing Address - Country:US
Mailing Address - Phone:832-962-9121
Mailing Address - Fax:832-218-6416
Practice Address - Street 1:4610 KATY HOCKLEY CUT OFF RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-7838
Practice Address - Country:US
Practice Address - Phone:832-962-9121
Practice Address - Fax:832-218-6416
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-3286665OtherSYNERGY DIAGNOSTICS LLC