Provider Demographics
NPI:1982813200
Name:COUCH, BRIANNA MICHALOSKY (MD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MICHALOSKY
Last Name:COUCH
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 1:10571 TELEGRAPH RD
Mailing Address - Street 2:SUITE
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4652
Mailing Address - Country:US
Mailing Address - Phone:804-545-5067
Mailing Address - Fax:
Practice Address - Street 1:10571 TELEGRAPH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4652
Practice Address - Country:US
Practice Address - Phone:804-545-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018357390200000X
VA0101245851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program