Healthcare Provider Details

I. General information

NPI: 1871973172
Provider Name (Legal Business Name): PATRICK COURTRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST 6TH FLOOR
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

245 N 15TH ST 6TH FLOOR
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7916
  • Fax: 215-762-7765
Mailing address:
  • Phone: 215-762-7916
  • Fax: 215-762-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT208661
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number282415
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: