Provider Demographics
NPI:1770574212
Name:CAPITO, CHARLES PETER (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PETER
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 1:703 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
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12032207X00000X
OH56741207X00000X
PAMD037652E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV200006969OtherRR MEDICARE
OH0598929Medicaid
WV0099372000Medicaid
OH200020738OtherRR MEDICARE
OH0598929Medicaid
WV0099372000Medicaid
OH0552164Medicare PIN