Provider Demographics
NPI:1801159587
Name:COUK, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COUK
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 1:5228 MYERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTON
Mailing Address - State:VA
Mailing Address - Zip Code:22724-2031
Mailing Address - Country:US
Mailing Address - Phone:540-937-7865
Mailing Address - Fax:
Practice Address - Street 1:5228 MYERS MILL RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTON
Practice Address - State:VA
Practice Address - Zip Code:22724-2031
Practice Address - Country:US
Practice Address - Phone:540-937-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010106393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist