Healthcare Provider Details

I. General information

NPI: 1205917440
Provider Name (Legal Business Name): GRACE MARIE COUCHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 LAKE DRIVE SUITE 301
RALEIGH NC
27607
US

IV. Provider business mailing address

2601 LAKE DRIVE SUITE 301
RALEIGH NC
27607
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-6911
  • Fax: 919-861-6400
Mailing address:
  • Phone: 919-782-6911
  • Fax: 919-861-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number31795
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: