Provider Demographics
NPI:1528267077
Name:HOTIANA, MATEEN M (MD)
Entity type:Individual
Prefix:
First Name:MATEEN
Middle Name:M
Last Name:HOTIANA
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 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-1000
Mailing Address - Fax:
Practice Address - Street 1:1249 15TH ST STE 3000
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3663
Practice Address - Country:US
Practice Address - Phone:304-691-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22887207R00000X, 207RE0101X
OH35120030207RE0101X
WVTMP-01816207R00000X
NHLT-4345207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2802202Medicaid
WV3810010258Medicaid
OHH131150Medicare PIN
WV4218922Medicare PIN