MEDICARE: COURTNEY JILL WARNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	MT194688	PA
2	2086S0129X	Vascular Surgery Physician	RT-2136	NH
3	2086S0129X	Vascular Surgery Physician	279367	NY

General Provider Information

NPI Number	:	1588891220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JILL WARNER M.D.

Provider Business Mailing Address
First Line	:	391 MYRTLE AVE STE 5
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3797
Country	:	US
Telephone Number	:	518-262-5640
Fax Number	:	518-262-9413

Provider Business Practice Location Address
First Line	:	3 CARE LN
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-8639
Country	:	US
Telephone Number	:	518-792-7122
Fax Number	:	518-792-3800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2009
Last Update Date	:	07/21/2022

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