Provider Demographics
NPI:1649968462
Name:SYNERGY MED
Entity type:Organization
Organization Name:SYNERGY MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAHITHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUPPAVARAPU
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?:Yes
Parent Organization LBN:SYNERGY MED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care