Physician Compare National (NPI:1235472176)

HEALTHCARE PROVIDER: COURTNEY WEATHERSBY BAGAYOKO M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1235472176
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577837772
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200226002807
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BAGAYOKO
	Individual professional last name
Provider First Name	COURTNEY
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ANCHORAGE DERMATOLOGY AND COSMETICS, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7416288550
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	615 E 82ND AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 204
	Group Practice or individual's line 2 address
City	ANCHORAGE
	Group Practice or individual's city
State	AK
	Group Practice or individual's state
Zip Code	995183159
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9078658455
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y