MEDICARE: MRS. SUZANNE WHITNEY COURTNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2052	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00363062	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	001886752	OTHER	WV	BLUE CROSS BLUE SHIELD
3	WV2052	OTHER	WV	HEALTH PLAN OF UPPER OHIO
4	550525724	OTHER	WV	TAX IDENTIFICATION

General Provider Information

NPI Number	:	1568498277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE WHITNEY COURTNEY MD

Provider Business Mailing Address
First Line	:	527 MEDICAL PARK DR STE 500
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330-9010
Country	:	US
Telephone Number	:	681-342-3600
Fax Number	:	681-342-3625

Provider Business Practice Location Address
First Line	:	527 MEDICAL PARK DR STE 500
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330-9010
Country	:	US
Telephone Number	:	681-342-3600
Fax Number	:	681-342-3625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	04/06/2022

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Directions to “ MRS. SUZANNE WHITNEY COURTNEY MD” Practice Location

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