Provider Demographics
NPI:1730360918
Name:CHARLESTON NEUROLOGY ASSC INC
Entity type:Organization
Organization Name:CHARLESTON NEUROLOGY ASSC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-345-1181
Mailing Address - Street 1:5303 MACCORKLE AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2221
Mailing Address - Country:US
Mailing Address - Phone:304-345-1181
Mailing Address - Fax:304-345-1183
Practice Address - Street 1:5303 MACCORKLE AVE SE STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2221
Practice Address - Country:US
Practice Address - Phone:304-345-1181
Practice Address - Fax:304-345-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty