Healthcare Provider Details

I. General information

NPI: 1912212655
Provider Name (Legal Business Name): CORTNEY CELESTE BLEACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORTNEY CELESTE WILSON M.D.

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4494 PALMER RD
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4959
  • Fax: 301-319-2420
Mailing address:
  • Phone: 301-295-4959
  • Fax: 301-319-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012-01297
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2012-01297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: