Healthcare Provider Details

I. General information

NPI: 1801232046
Provider Name (Legal Business Name): LEAH A COUTURE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY BLDG 460C
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

201 E UNIVERSITY PKWY BLDG 460C
BALTIMORE MD
21218-2829
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberD0089710
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: