MEDICARE: DR. STEVEN WALTER COUTRAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	D0042166	MD
2	207Y00000X	Otolaryngology Physician	D0042166	MD
3	207Y00000X	Otolaryngology Physician	13660	NH
4	207YS0012X	Sleep Medicine (Otolaryngology) Physician	13660	NH
5	207YX0602X	Otolaryngic Allergy Physician	13660	NH
6	207Y00000X	Otolaryngology Physician	18329	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417953084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN WALTER COUTRAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 780
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26507-0780
Country	:	US
Telephone Number	:	304-285-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER DRIVE
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26506
Country	:	US
Telephone Number	:	304-293-3457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/12/2022

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