1851704779 NPI number — DEIRDRE L COURTNEY AU.D.

Table of content: DEIRDRE L COURTNEY AU.D. (NPI 1851704779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851704779 NPI number — DEIRDRE L COURTNEY AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COURTNEY
Provider First Name:
DEIRDRE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851704779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3615 E JOPPA RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-3386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-944-3100
Provider Business Mailing Address Fax Number:
866-253-2466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7845 OAKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-4280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
107-604-3274
Provider Business Practice Location Address Fax Number:
866-253-2466
Provider Enumeration Date:
06/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231HA2400X , with the licence number:  01322 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 01322 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01322 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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