Provider Demographics
NPI: | 1174523393 |
---|---|
Name: | SINBACK, MARSHALL FRANCIS JR (PA-C) |
Entity type: | Individual |
Prefix: | MR |
First Name: | MARSHALL |
Middle Name: | FRANCIS |
Last Name: | SINBACK |
Suffix: | JR |
Gender: | M |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3029 SARATOGA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | WINCHESTER |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22601-2697 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-678-3808 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 510 BUTLER AVE |
Practice Address - Street 2: | MARTINSBURG VA MEDICAL CENTER |
Practice Address - City: | MARTINSBURG |
Practice Address - State: | WV |
Practice Address - Zip Code: | 25401-9990 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-263-0811 |
Practice Address - Fax: | 304-262-1397 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2005-07-29 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0110002091 | 363A00000X, 363AS0400X |
MA | 1346 | 363A00000X, 363AS0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
Not Answered | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |