Provider Demographics
NPI:1205917440
Name:COUCHMAN, GRACE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MARIE
Last Name:COUCHMAN
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 1:2601 LAKE DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-782-6911
Mailing Address - Fax:919-861-6400
Practice Address - Street 1:2601 LAKE DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-782-6911
Practice Address - Fax:919-861-6400
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31795207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10916230OtherCAQH NUMBER
NC10916230OtherCAQH NUMBER