Provider Demographics
NPI:1891893889
Name:CHARLES P CAPITO
Entity Type:Organization
Organization Name:CHARLES P CAPITO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CAPITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-3355
Mailing Address - Street 1:703 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5016
Mailing Address - Country:US
Mailing Address - Phone:304-723-3355
Mailing Address - Fax:304-723-5638
Practice Address - Street 1:703 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5016
Practice Address - Country:US
Practice Address - Phone:304-723-3355
Practice Address - Fax:304-723-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12032207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0598929Medicaid
WV1812251000Medicaid
OH2340792Medicaid
WV0099372000Medicaid
OH0598929Medicaid
WV0099372000Medicaid
OH9326392Medicare PIN
WV0487300001Medicare NSC