Provider Demographics
NPI:1093797086
Name:MARSH, COURTNEY WALSH (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WALSH
Last Name:MARSH
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:19465 DEERFIELD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1701
Practice Address - Country:US
Practice Address - Phone:703-726-1300
Practice Address - Fax:703-726-9612
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168983367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093797086Medicaid
VAVAA104055Medicare PIN