Jackson, Theodore A.

Jackson, Theodore A. is an individual health care provider with primary practice located at 1306 Kanawha Blvd E Suite 100, Charleston WV 25301-3001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic Surgery, Allopathic & Osteopathic Physicians / Surgery of the Hand. Allopathic & Osteopathic Physicians / Plastic Surgery is his primary health care specialty. Jackson, Theodore A. can be contacted via phone (304) 342-1113.

Contact Information

Primary practice address
1306 Kanawha Blvd E Suite 100 Charleston WV 25301-3001
Phone: (304) 342-1113
Fax: (304) 346-2271
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 13531 West Virginia
Allopathic & Osteopathic Physicians / Surgery of the Hand 2082S0105X 13531 West Virginia

Profile Details

NPI number 1942294376
LBN Legal business name Jackson, Theodore A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2005
Last updated Mar 12th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942294376 NPPES
West Virginia MEDICAID 0051155000

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