Provider Demographics
NPI:1508893587
Name:STEPHEN H SINCLAIR MD PC
Entity Type:Organization
Organization Name:STEPHEN H SINCLAIR MD PC
Other - Org Name:SINCLAIR RETINA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-892-1708
Mailing Address - Street 1:200 E STATE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-892-1708
Mailing Address - Fax:
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-892-1708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022777E207W00000X
DEC10004246207W00000X
PAMD420302207W00000X
DEC10007285207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF95520OtherAMERI HEALTH ADMIN
PA0794182000OtherBLAIR MILL AMERI HEALTH
PA1002072OtherKEYSTONE MERCY HEALTH PLA
PA31188OtherAETNA US HEALTHCARE
PA0794182000OtherKEYSTONE HEALTHPLAN
PA695520OtherBLUE SHIELD OF PA
PA695520OtherBLUE SHIELD OF PA
PAF95520OtherAMERI HEALTH ADMIN
PA695520Medicare ID - Type UnspecifiedPA MEDICARE