Provider Demographics
NPI:1528036191
Name:SINCAVAGE, DAVID LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LOUIS
Last Name:SINCAVAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 RAVEN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8604
Mailing Address - Country:US
Mailing Address - Phone:619-850-4224
Mailing Address - Fax:815-572-9656
Practice Address - Street 1:9421 RAVEN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8604
Practice Address - Country:US
Practice Address - Phone:619-850-4224
Practice Address - Fax:815-572-9656
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE07546207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G545370Medicaid
CA00G545370Medicaid
CACM862WMedicare PIN