Healthcare Provider Details

I. General information

NPI: 1083822704
Provider Name (Legal Business Name): NATARIO COUSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/16/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTH WOLFE ST
BALTIMORE MD
21264-1930
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-1340
  • Fax:
Mailing address:
  • Phone: 410-933-1340
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberD0101408
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101249717
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0101408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: