Provider Demographics
NPI:1881043016
Name:COUCH, LUCAS (DO)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:COUCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5405
Mailing Address - Country:US
Mailing Address - Phone:704-668-1029
Mailing Address - Fax:
Practice Address - Street 1:444 WMC DR STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-4337
Practice Address - Country:US
Practice Address - Phone:410-751-2595
Practice Address - Fax:410-751-2593
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH87705207Q00000X
NC217770390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program