1285611004 NPI number — MICHAEL VINCENT KORONA JR. MD

Table of content: MICHAEL VINCENT KORONA JR. MD (NPI 1285611004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285611004 NPI number — MICHAEL VINCENT KORONA JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORONA
Provider First Name:
MICHAEL
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285611004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910
Provider Second Line Business Mailing Address:
RADIOLOGY INC
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25712-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-522-1550
Provider Business Mailing Address Fax Number:
304-522-1073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5221 US ROUTE 60 E
Provider Second Line Business Practice Location Address:
RADIOLOGY INC
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-1550
Provider Business Practice Location Address Fax Number:
304-522-0704
Provider Enumeration Date:
12/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35-08-0594-K , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 31771 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 31771 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 18082 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0120483000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4293965 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50007257 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000714943 . This is a "MTN STATE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000196665 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6494052100 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300046826 . This is a "RR MEDICARE (WV)" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 55049337600 . This is a "WORKMANS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0130496 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".