Provider Demographics
NPI:1598709180
Name:COUVRETTE, CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:COUVRETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1818
Mailing Address - Country:US
Mailing Address - Phone:814-437-2764
Mailing Address - Fax:
Practice Address - Street 1:100 LAKEWOOD CIRCLE
Practice Address - Street 2:POLK CENTER
Practice Address - City:POLK
Practice Address - State:PA
Practice Address - Zip Code:16342
Practice Address - Country:US
Practice Address - Phone:814-432-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043817E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACO608978Medicaid
PAE79158Medicare UPIN
PA080167235Medicare PIN
PA608978Medicare ID - Type Unspecified