1508893587 NPI number — STEPHEN H SINCLAIR MD PC

Table of content: (NPI 1508893587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508893587 NPI number — STEPHEN H SINCLAIR MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN H SINCLAIR MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SINCLAIR RETINA ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508893587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E STATE ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-3434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-892-1708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E STATE ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-3434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-892-1708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINCLAIR
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-892-1708

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD022777E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: C10004246 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD420302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: C10007285 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F95520 . This is a "AMERI HEALTH ADMIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0794182000 . This is a "BLAIR MILL AMERI HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1002072 . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31188 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0794182000 . This is a "KEYSTONE HEALTHPLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 695520 . This is a "BLUE SHIELD OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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