Provider Demographics
NPI:1174952998
Name:SYNCHRONY NEUROLOGIC, PLLC
Entity type:Organization
Organization Name:SYNCHRONY NEUROLOGIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-771-0107
Mailing Address - Street 1:7180 E ORCHARD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1724
Mailing Address - Country:US
Mailing Address - Phone:303-771-0107
Mailing Address - Fax:303-991-5961
Practice Address - Street 1:7180 E ORCHARD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1724
Practice Address - Country:US
Practice Address - Phone:303-771-0107
Practice Address - Fax:303-991-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO456512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty