Provider Demographics
NPI:1528181203
Name:CAPITOL NEUROLOGY PLLC
Entity Type:Organization
Organization Name:CAPITOL NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:REAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-342-3891
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-1323
Mailing Address - Country:US
Mailing Address - Phone:304-722-4867
Mailing Address - Fax:304-722-5867
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-342-3891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV186942084N0400X
WV186952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006892Medicaid
WV3810006892Medicaid