Healthcare Provider Details

I. General information

NPI: 1740227909
Provider Name (Legal Business Name): FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROGERS ST
PRINCETON WV
24740-3636
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 800-292-3008
  • Fax: 412-291-1552
Mailing address:
  • Phone: 800-292-3008
  • Fax: 866-420-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY J DONATELLI
Title or Position: OWNER
Credential: DPM
Phone: 800-292-3008