| Synergy Revitalize Med & Spa Center | |
|
5457 Twin Knolls Rd Ste 300-s11 Columbia MD 21045-3259 | |
| (216) 357-8977 | |
| Not Available |
| Full Name | Synergy Revitalize Med & Spa Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 5457 Twin Knolls Rd Ste 300-s11, Columbia, Maryland |
| Authorized Official Name and Position | Elaine M Taylor (CEO) |
| Authorized Official Contact | 3016024658 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Synergy Revitalize Med & Spa Center 5457 Twin Knolls Rd Ste 300-s11 Columbia MD 21045-3259 Ph: (301) 602-4658 | Synergy Revitalize Med & Spa Center 5457 Twin Knolls Rd Ste 300-s11 Columbia MD 21045-3259 Ph: (216) 357-8977 |
| NPI Number | 1558006957 |
|---|---|
| Provider Enumeration Date | 04/29/2022 |
| Last Update Date | 05/08/2024 |
| Medicare PECOS PAC ID | 5193103349 |
|---|---|
| Medicare Enrollment ID | O20220601000393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558006957 | NPI | - | NPPES |
| 598055100 | Medicaid | MD | |
| 1295045755 | Other | MA | NPPES |
| Provider Name | Elaine Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295045755 PECOS PAC ID: 8921372269 Enrollment ID: I20210209001606 |
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