Provider Demographics
NPI:1679542443
Name:SINCLAIR, STEPHEN H (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:SINCLAIR
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 1:200 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:610-892-7866
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:610-892-7866
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022777E207W00000X
DEC10004246207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015279550001Medicaid
PA0053177000OtherKEYSTONE INDIVIDULE ID #
PA31188OtherAETNA US HEALTHCARE
PA7016527003OtherCIGNA
PA0794182000OtherKEYSTONE GROUP ID
PA119503OtherBLUE CROSS BLUE SHIELD
PAA19503OtherAMERIHEALTH
PA119503OtherBLUE CROSS BLUE SHIELD
DE000G30S36Medicare ID - Type UnspecifiedDELAWARE MEDICARE
PA119503OtherBLUE CROSS BLUE SHIELD
DE0000659401Medicare ID - Type UnspecifiedDELAWARE MEDICADE