Healthcare Provider Details

I. General information

NPI: 1215936463
Provider Name (Legal Business Name): ENRICO J CAPPIELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEW HOPE RD QUAIL VALLEY MEDICAL CENTER SUITE 7
PRINCETON WV
24740-2155
US

IV. Provider business mailing address

200 NEW HOPE RD PO BOX 1559
PRINCETON WV
24740-2155
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-1076
  • Fax: 304-425-9499
Mailing address:
  • Phone: 304-487-1076
  • Fax: 304-425-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14100
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: