Healthcare Provider Details

I. General information

NPI: 1275584872
Provider Name (Legal Business Name): SUSAN C CAPELLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3496 UNIVERSITY AVE
MORGANTOWN WV
26505-3001
US

IV. Provider business mailing address

3496 UNIVERSITY AVE
MORGANTOWN WV
26505-3001
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-7075
  • Fax: 304-581-6800
Mailing address:
  • Phone: 304-599-7075
  • Fax: 304-581-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number20147
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number20147
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number20147
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: