Provider Demographics
NPI:1285611004
Name:KORONA, MICHAEL VINCENT JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VINCENT
Last Name:KORONA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:5221 US ROUTE 60 E
Practice Address - Street 2:RADIOLOGY INC
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-0594-K2085R0202X
KY317712085R0202X, 2085R0204X
WV180822085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0120483000Medicaid
4293965OtherAETNA
KY50007257OtherPASSPORT
000714943OtherMTN STATE BCBS
OH000000196665OtherUNISON
KY6494052100Medicaid
WV300046826OtherRR MEDICARE (WV)
WV55049337600OtherWORKMANS COMP
OH0130496Medicaid
KY50007257OtherPASSPORT
OH000000196665OtherUNISON
KY0683109Medicare PIN
F50857Medicare UPIN