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
1	208800000X	Urology Physician	MD-46056	IA
2	208800000X	Urology Physician	0101239642	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01081069	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	463937	OTHER	VA	SOUTHERN HEALTH
3	199795	OTHER	VA	ANTHEM
5	MEDICAID 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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