Provider Demographics
NPI:1225196751
Name:CHARLES J COURTNEY
Entity Type:Organization
Organization Name:CHARLES J COURTNEY
Other - Org Name:UNIVERSAL ARTIFICIAL LIMB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-587-6892
Mailing Address - Street 1:8625 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2261
Mailing Address - Country:US
Mailing Address - Phone:301-587-6892
Mailing Address - Fax:301-587-2750
Practice Address - Street 1:8625 16TH ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2261
Practice Address - Country:US
Practice Address - Phone:301-587-6892
Practice Address - Fax:301-587-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC022465600Medicaid
MD765958000Medicaid
VA009190813Medicaid
MD0512590001Medicare ID - Type Unspecified