1750776852 NPI number — MRS. MEGAN ELIZABETH COUFAL DPT

Table of content: MRS. MEGAN ELIZABETH COUFAL DPT (NPI 1750776852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750776852 NPI number — MRS. MEGAN ELIZABETH COUFAL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUFAL
Provider First Name:
MEGAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MENTNECH
Provider Other First Name:
MEGAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750776852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 BALTIMORE ANNAPOLIS BLVD
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-544-2500
Provider Business Mailing Address Fax Number:
410-384-9703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 BALTIMORE ANNAPOLIS BLVD
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-544-2500
Provider Business Practice Location Address Fax Number:
410-384-9703
Provider Enumeration Date:
04/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  25297 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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