Provider Demographics
NPI:1457337974
Name:COUTURE, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:COUTURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 INDIAN GRAVE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-9100
Mailing Address - Country:US
Mailing Address - Phone:540-283-2570
Mailing Address - Fax:540-283-2575
Practice Address - Street 1:5304 INDIAN GRAVE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-9100
Practice Address - Country:US
Practice Address - Phone:540-283-2570
Practice Address - Fax:540-283-2575
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457337974Medicaid
VA006095232Medicaid
VAP00276857OtherMEDICARE RAILROAD
E85839Medicare UPIN
VAP00276857OtherMEDICARE RAILROAD