Provider Demographics
NPI:1346274925
Name:DAMATO, KENNETH EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWARD
Last Name:DAMATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRAL WV MEDCORP, INC.
Mailing Address - Street 2:PO BOX 2630
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-637-3799
Mailing Address - Fax:304-637-3369
Practice Address - Street 1:100 SENECA ROAD
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-1457
Practice Address - Country:US
Practice Address - Phone:304-636-8080
Practice Address - Fax:304-636-8849
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1153207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV01153OtherHEALTH PLAN
P00247557OtherRAILROAD MEDICARE
WV0097229000Medicaid
WVWV01153OtherHEALTH PLAN
WVE05911Medicare UPIN
WVD 0616004Medicare PIN