Healthcare Provider Details

I. General information

NPI: 1982720645
Provider Name (Legal Business Name): ALVARO R GUTIERREZ NEUROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 CHEAT RD
MORGANTOWN WV
26508-4451
US

IV. Provider business mailing address

2199 CHEAT RD
MORGANTOWN WV
26508-4451
US

V. Phone/Fax

Practice location:
  • Phone: 304-594-3258
  • Fax: 304-594-3498
Mailing address:
  • Phone: 304-594-3258
  • Fax: 304-594-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number14079
License Number StateWV

VIII. Authorized Official

Name: DR. ALVARO RAFAEL GUTIERREZ
Title or Position: OWNER
Credential: M.D.
Phone: 304-594-3258