Basic Information
Provider Information | |||||||||
NPI: | 1003884586 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SINCLAIR | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | CARSON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 421 W CHEW ST | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181023406 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6107765100 | ||||||||
FaxNumber: | 6106633113 | ||||||||
Practice Location | |||||||||
Address1: | 451 W CHEW ST | ||||||||
Address2: | SUITE 409 | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181023472 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6107703130 | ||||||||
FaxNumber: | 6107703452 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/09/2006 | ||||||||
LastUpdateDate: | 12/11/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD022183E | PA | Y |   | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |   |
ID Information
ID | Type | State | Issuer | Description | 0006407890008 | 05 | PA |   | MEDICAID | 105256 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 50057845 | 01 |   | CBC | OTHER | 187958 | 01 |   | UNISON | OTHER | 0040164000 | 01 |   | IBC | OTHER | 20049133 | 01 |   | AMERIHEALTH MERCY | OTHER | 1518431 | 01 |   | GATEWAY HEALTH PLAN | OTHER |