Healthcare Provider Details

I. General information

NPI: 1760418255
Provider Name (Legal Business Name): WESTERN PA NEUROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEASANT VILLAGE LN
BELLE VERNON PA
15012-4333
US

IV. Provider business mailing address

100 PEASANT VILLAGE LN
BELLE VERNON PA
15012-4333
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-7800
  • Fax: 724-929-3229
Mailing address:
  • Phone: 724-929-7800
  • Fax: 724-929-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES PATRICK GENNAULA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 724-929-7800