Provider Demographics
NPI:1053312314
Name:KURT M. NELLHAUS, M.D.
Entity Type:Organization
Organization Name:KURT M. NELLHAUS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-344-9480
Mailing Address - Street 1:PO BOX 890805
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0805
Mailing Address - Country:US
Mailing Address - Phone:216-464-5160
Mailing Address - Fax:216-464-5982
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 806
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-344-9480
Practice Address - Fax:304-344-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000454000Medicaid
WVNESP03001Medicare ID - Type Unspecified