Healthcare Provider Details

I. General information

NPI: 1265964159
Provider Name (Legal Business Name): COURTNEY LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W CHELTENHAM AVE STE 205
WYNCOTE PA
19095-2956
US

IV. Provider business mailing address

PO BOX 746722
ATLANTA GA
30374-6722
US

V. Phone/Fax

Practice location:
  • Phone: 215-444-7471
  • Fax: 215-695-2935
Mailing address:
  • Phone: 312-733-9730
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD471716
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD471716
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: