Provider Demographics
NPI:1205830122
Name:PALMER, COURTNEY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:S
Last Name:PALMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WEST ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2824
Mailing Address - Country:US
Mailing Address - Phone:410-573-1111
Mailing Address - Fax:410-573-1377
Practice Address - Street 1:168 WEST ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2824
Practice Address - Country:US
Practice Address - Phone:410-573-1111
Practice Address - Fax:410-573-1377
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00542213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1401421OtherCIGNA
MD1565-0001OtherCAREFIRST BCBS DC, FED
MDT195OtherCAREFIRST BCBS MD
MD219575OtherMAMSI
MD258908700Medicaid
MD08400OtherAMERIGROUP
MD258908700Medicaid
MD184297P40Medicare PIN
MD480033726Medicare PIN
MD1401421OtherCIGNA
MD08400OtherAMERIGROUP
MD0469350002Medicare NSC