Provider Demographics
NPI:1407816416
Name:KATINY, ANTOINE (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:
Last Name:KATINY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MUNICIPAL STREET
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26335-0424
Mailing Address - Country:US
Mailing Address - Phone:304-853-2278
Mailing Address - Fax:304-853-2520
Practice Address - Street 1:110 MUNICIPAL STREET
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26335-0424
Practice Address - Country:US
Practice Address - Phone:304-853-2278
Practice Address - Fax:304-853-2520
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075944000Medicaid
WV0034771000Medicaid
WVKA0751213Medicare PIN
WVF60719Medicare UPIN
WV513884Medicare Oscar/Certification
WV0034771000Medicaid
WVKA2029191Medicare PIN
WV110075846Medicare PIN