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General NPI Number Information
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NPI Number | 1396532719
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CLINIC OF THE VIRGINIAS, INC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 5504 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2320
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Country | US
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Telephone | 304-926-8637
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 301-933-7133
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Fax |
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Authorized Official
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Title or Position | DPM
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Name | TIMOTHY JOHN DONATELLI
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Credential |
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Telephone | 304-228-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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