Healthcare Provider Details

I. General information

NPI: 1649252875
Provider Name (Legal Business Name): LEO A. COURTNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 TEWKESBURY LANE
SEVERNA PARK MD
21146
US

IV. Provider business mailing address

690 TEWKESBURY LANE
SEVERNA PARK MD
21146
US

V. Phone/Fax

Practice location:
  • Phone: 410-647-7942
  • Fax: 410-647-5188
Mailing address:
  • Phone: 410-647-7942
  • Fax: 410-647-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0012537
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: