Provider Demographics
NPI:1265517858
Name:TIANO, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:TIANO
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 1:20 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0000
Mailing Address - Country:US
Mailing Address - Phone:304-831-1602
Mailing Address - Fax:304-831-1605
Practice Address - Street 1:20 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-0000
Practice Address - Country:US
Practice Address - Phone:304-831-1602
Practice Address - Fax:304-831-1605
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004162Medicaid
KY64113574Medicaid
WVTI4168621Medicare ID - Type Unspecified
WV3810004162Medicaid