MEDICARE: FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1780471177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC

Provider Business Mailing Address
First Line	:	PO BOX 825159
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5159
Country	:	US
Telephone Number	:	301-933-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9796
Country	:	US
Telephone Number	:	304-757-3668
Fax Number	:

Authorized Official
Title or Position	:	DPM
Name	:	TIMOTHY JOHN DONATELLI
Credential	:
Telephone Number	:	304-228-8888

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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