MEDICARE: DR. RICHARD A. CAPITO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	12654	WV
2	207R00000X	Internal Medicine Physician	12654	WV

General Provider Information

NPI Number	:	1407858772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A. CAPITO MD

Provider Business Mailing Address
First Line	:	4605 MACCORKLE AVENUE, SW
Second Line	:	THS PHYSICIAN PARTNERS, INC.-ADMIN OFC
City	:	S CHARLESTON
State	:	WV
Zip	:	25309
Country	:	US
Telephone Number	:	304-414-4800
Fax Number	:	304-414-4801

Provider Business Practice Location Address
First Line	:	1097 FLEDDERJOHN RD
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25314
Country	:	US
Telephone Number	:	304-345-3627
Fax Number	:	304-346-4440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/22/2021

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