Provider Demographics
NPI:1477019255
Name:SYNERGY MED
Entity type:Organization
Organization Name:SYNERGY MED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAHITHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NANDANOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:209-472-2300
Mailing Address - Street 1:1801 E MARCH LN STE D460
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6680
Mailing Address - Country:US
Mailing Address - Phone:209-472-2300
Mailing Address - Fax:209-472-2446
Practice Address - Street 1:1801 E MARCH LN STE D460
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6680
Practice Address - Country:US
Practice Address - Phone:209-472-2300
Practice Address - Fax:209-472-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-16
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1053725820Medicaid