Provider Demographics
NPI:1285662098
Name:SINNOTT, WILLIAM P (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:SINNOTT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6416
Mailing Address - Country:US
Mailing Address - Phone:740-383-7950
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7950
Practice Address - Fax:740-375-8164
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002196363A00000X
OH50.000053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071602Medicaid
OH0071602Medicaid
MIN8281002Medicare PIN
MIS57916Medicare UPIN
OHPA11531Medicare PIN