Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS039158 | PA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS039158 | PA |
NPI | 1144576240 |
---|---|
Provider Name | Dr. Michael Courtney |
First Address | Philadelphia, PA 19107-5441 |
Second Address | Lowell, MA 01852-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2012 |
Last Update Date | 17/03/2018 |