Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 20147 | WV |
NPI | 1275584872 |
---|---|
Provider Name | Susan C Capelle |
First Address | Morgantown, WV 26505-3001 |
Second Address | Morgantown, WV 26505-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 05/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6200220000 | (05) | WV |
F89851 | (02) | WV |