Healthcare Provider Details

I. General information

NPI: 1053517516
Provider Name (Legal Business Name): JOSEPH ANTHONY COUVILLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

PO BOX 880
LIMA OH
45802-0880
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-8750
  • Fax: 540-536-8827
Mailing address:
  • Phone: 727-286-8929
  • Fax: 727-286-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME105648
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME 105648
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036161045
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036161045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: