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Contact Information

THEODORE A JACKSON, MD
1306 KANAWHA BLVD E
SUITE 100
CHARLESTON, WV25301-3001
 Phone: 304-342-1113
 Fax: 304-346-2271
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Plastic Surgery

208200000X 02 Physician/General Surgery
 

Surgery of the Hand

2082S0105X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for THEODORE A JACKSON · (Male)

NPI # 1942294376
Status Active
Credentials MD
Entity Individual
Enumeration date 08/31/2005
Last updated 03/12/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • WV License # 13531
  • WV Medicaid 0051155000
Hospital affiliation(s)
  • CHARLESTON AREA MEDICAL CENTER - (Acute Care)
    501 MORRIS STREET
    CHARLESTON, WV 25301
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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