Provider Demographics
NPI:1083750335
Name:KANAWHA VALLEY FOOT AND ANKLE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:KANAWHA VALLEY FOOT AND ANKLE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:NOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-727-9200
Mailing Address - Street 1:209 FOURTH AVE
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2821
Mailing Address - Country:US
Mailing Address - Phone:304-727-9200
Mailing Address - Fax:304-727-6999
Practice Address - Street 1:209 FOURTH AVE
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2821
Practice Address - Country:US
Practice Address - Phone:304-727-9200
Practice Address - Fax:304-727-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00373213ES0103X
WV00367213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006007Medicaid
WV001706456OtherMSBCBS
WV001706456OtherMSBCBS
WV9319331Medicare PIN