Provider Demographics
NPI:1669867651
Name:COUTURE, DANIELLE CHUNG (MD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:CHUNG
Last Name:COUTURE
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 1:4950 PARKSIDE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4700
Mailing Address - Country:US
Mailing Address - Phone:267-225-1677
Mailing Address - Fax:
Practice Address - Street 1:4950 PARKSIDE AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4700
Practice Address - Country:US
Practice Address - Phone:267-225-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT2081482084P0800X
PAMD4617162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry