Individual
TIMOTHY JOHN DONATELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
401 ROGERS ST, PRINCETON, WV 24740-3636
(304) 487-9442
(304) 431-3558
Mailing address
PO BOX 365, PROSPERITY, WV 25909-0365
(304) 228-8888
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
0103300831
VA
213E00000X
Podiatrist
Primary
WV 00363
WV
213EP1101X
Primary Podiatric Medicine Podiatrist
36003209D
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010201641
—
VA
05
—
2101008000
—
WV
01
—
300175239
WV WORKERS' COMPENSATION
WV
01
—
300175239
UMWA
—
01
—
5467800001
MEDICARE DME
—
01
—
P00220975
RAILROAD MEDICARE
—
Enumeration date
04/10/2006
Last updated
11/04/2009
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