Healthcare Provider Details

I. General information

NPI: 1972813996
Provider Name (Legal Business Name): JOSEPH JEFFERDS SINCLAIR MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LEE ST E SUITE 150
CHARLESTON WV
25301-3200
US

IV. Provider business mailing address

500 LEE ST E SUITE 150
CHARLESTON WV
25301-3200
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-3937
  • Fax: 304-343-1590
Mailing address:
  • Phone: 304-343-3937
  • Fax: 304-343-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number24250
License Number StateWV

VIII. Authorized Official

Name: DR. JOSEPH JEFFERDS SINCLAIR
Title or Position: CEO
Credential: MD
Phone: 304-343-3937