Individual
ELAINE TINA KOUKOULAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6535 N CHARLES ST, SUITE 300, TOWSON, MD 21204-5826
(410) 938-5252
(410) 928-5250
Mailing address
6501 N CHARLES ST, BALTIMORE, MD 21204-6819
(410) 938-3000
(410) 938-5131
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D0059124
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5116023-00
—
MD
Enumeration date
10/02/2006
Last updated
02/26/2020
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