MEDICARE: COURTNEY WHITELOCK

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	345116	NY

General Provider Information

NPI Number	:	1730743170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY WHITELOCK

Provider Business Mailing Address
First Line	:	101 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:	631-689-8333
Fax Number	:

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

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	06/23/2026

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Directions to “ COURTNEY WHITELOCK ” Practice Location

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