Provider Demographics
NPI:1659086585
Name:SYNERGY MEDICAL COLLECTIVE, PA
Entity Type:Organization
Organization Name:SYNERGY MEDICAL COLLECTIVE, PA
Other - Org Name:SYNERGY MEDICAL COLLECTIVE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-599-4089
Mailing Address - Street 1:PO BOX 749063
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9063
Mailing Address - Country:US
Mailing Address - Phone:919-599-4089
Mailing Address - Fax:
Practice Address - Street 1:2500 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2805
Practice Address - Country:US
Practice Address - Phone:305-264-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Single Specialty