Provider Demographics
NPI:1932159704
Name:CHIANESE, JAMES LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:CHIANESE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3636
Mailing Address - Country:US
Mailing Address - Phone:304-487-9442
Mailing Address - Fax:800-543-2360
Practice Address - Street 1:401 ROGERS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3636
Practice Address - Country:US
Practice Address - Phone:304-487-9442
Practice Address - Fax:800-543-2360
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10394213ES0103X
VA0103300973213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010377200Medicaid
VAP00361657OtherRR MEDICARE
WV3810007770Medicaid
WVP01232433OtherRR MEDICARE
WVCH4116872Medicare PIN
WVP01232433OtherRR MEDICARE