Provider Demographics
NPI:1770577280
Name:HYACINTHE, JEAN-MICHEL (MD)
Entity type:Individual
Prefix:MR
First Name:JEAN-MICHEL
Middle Name:
Last Name:HYACINTHE
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 1:400 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2806
Mailing Address - Country:US
Mailing Address - Phone:304-255-3844
Mailing Address - Fax:304-255-3846
Practice Address - Street 1:400 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2806
Practice Address - Country:US
Practice Address - Phone:304-255-3844
Practice Address - Fax:304-255-3846
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19225208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0114213-000Medicaid
WV0114213-000Medicaid
HY0841143Medicare ID - Type Unspecified