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NPI Code Detail

MEDICARE: DR. ERIC J SACKNOFF M.D.

MEDICARE:  DR. ERIC J SACKNOFF  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology PhysicianMD-46056IA
2208800000XUrology Physician0101239642VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P01081069OTHERVARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2463937OTHERVASOUTHERN HEALTH
3199795OTHERVAANTHEM
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295734598
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC J SACKNOFF M.D.
Provider Business Mailing Address
First Line : PO BOX 4190
Second Line :
City : BARBOURSVILLE
State : WV
Zip : 25504-4190
Country : US
Telephone Number : 304-908-9202
Fax Number : 304-399-2526
Provider Business Practice Location Address
First Line : 2900 1ST AVE STE 230
Second Line :
City : HUNTINGTON
State : WV
Zip : 25702-1241
Country : US
Telephone Number : 304-525-3711
Fax Number : 304-525-2748
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/09/2020

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Directions to “ DR. ERIC J SACKNOFF M.D.” Practice Location

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