Healthcare Provider Details

I. General information

NPI: 1225196751
Provider Name (Legal Business Name): CHARLES J COURTNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 16TH ST
SILVER SPRING MD
20910-2261
US

IV. Provider business mailing address

8625 16TH ST
SILVER SPRING MD
20910-2261
US

V. Phone/Fax

Practice location:
  • Phone: 301-587-6892
  • Fax: 301-587-2750
Mailing address:
  • Phone: 301-587-6892
  • Fax: 301-587-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHRYN L COURTNEY
Title or Position: MGR.
Credential:
Phone: 301-587-6892