Provider Demographics
NPI:1396726550
Name:ALATIS, STEPHEN RICHARD (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RICHARD
Last Name:ALATIS
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 1:651 COLLIERS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5058
Mailing Address - Country:US
Mailing Address - Phone:304-797-6560
Mailing Address - Fax:304-797-6404
Practice Address - Street 1:651 COLLIERS WAY STE 309
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5055
Practice Address - Country:US
Practice Address - Phone:304-797-6560
Practice Address - Fax:304-797-6560
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7884A207X00000X
PAOS-010351-L207X00000X
WV1935207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH200045493OtherRR MEDICARE
OH2340792Medicaid
WV200045217OtherRR MEDICARE
WV1812251-000Medicaid
OHP00383153OtherRR MEDICARE
WV4087371Medicare PIN
OH2340792Medicaid
OH4087374Medicare PIN
OHP00383153OtherRR MEDICARE
WV200045217OtherRR MEDICARE
WV4202211Medicare PIN