Healthcare Provider Details

I. General information

NPI: 1528181203
Provider Name (Legal Business Name): CAPITOL NEUROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST SUITE 100
CHARLESTON WV
25301-1842
US

IV. Provider business mailing address

PO BOX 1323
SAINT ALBANS WV
25177-1323
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-3891
  • Fax:
Mailing address:
  • Phone: 304-722-4867
  • Fax: 304-722-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18695
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18694
License Number StateWV

VIII. Authorized Official

Name: KIREN K REAHL
Title or Position: OWNER
Credential: MD
Phone: 304-342-3891