Healthcare Provider Details

I. General information

NPI: 1881043016
Provider Name (Legal Business Name): LUCAS COUCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 BANK CT
FREDERICK MD
21703-8483
US

IV. Provider business mailing address

1 FREDERICK HEALTH WAY
FREDERICK MD
21701-9435
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6310
  • Fax: 240-439-8913
Mailing address:
  • Phone: 240-215-6310
  • Fax: 240-439-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH87705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: