Provider Demographics
NPI:1407858772
Name:CAPITO, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:CAPITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MACCORKLE AVENUE, SW
Mailing Address - Street 2:THS PHYSICIAN PARTNERS, INC.-ADMIN OFC
Mailing Address - City:S CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:304-414-4801
Practice Address - Street 1:1097 FLEDDERJOHN RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314
Practice Address - Country:US
Practice Address - Phone:304-345-3627
Practice Address - Fax:304-346-4440
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12654207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1407858772Medicaid
WV3810024049OtherGROUP MEDICAID
WVB441OtherGROUP MEDICARE
WVB441OtherGROUP MEDICARE
WVA72215Medicare UPIN
WVB441OtherGROUP MEDICARE
WVP00435018Medicare PIN
WVA72215Medicare UPIN
WVP00353672Medicare PIN
WV0522587Medicare PIN