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General NPI Number Information
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NPI Number | 1760418255
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Entity Type | Organization
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Legal Business Name | WESTERN PA NEUROLOGY PC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 100 PEASANT VILLAGE LN
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City | BELLE VERNON
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State | PA
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Zip | 15012-4333
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Country | US
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Telephone | 724-929-7800
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Fax | 724-929-3229
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Provider Business Mailing Address
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Address Line | 100 PEASANT VILLAGE LN
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City | BELLE VERNON
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State | PA
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Zip | 15012-4333
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Country | US
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Telephone | 724-929-7800
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Fax | 724-929-3229
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES PATRICK GENNAULA
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Credential | M.D.
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Telephone | 724-929-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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