Provider Demographics
NPI:1508866633
Name:NELLHAUS, KURT M (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:M
Last Name:NELLHAUS
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 1:501 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-3574
Mailing Address - Fax:304-388-6481
Practice Address - Street 1:1738 LOUDON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1546
Practice Address - Country:US
Practice Address - Phone:304-546-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15554207RC0200X, 207RP1001X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000454000Medicaid
WV1508866633OtherBLUE CROSS BLUE SHIELD
WVNE4031854Medicare PIN
WV1508866633OtherBLUE CROSS BLUE SHIELD
WV1000454000Medicaid