Provider Demographics
NPI:1326432220
Name:GRANT, KOURTNEY TRUDGEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KOURTNEY
Middle Name:TRUDGEN
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KOURTNEY
Other - Middle Name:LYNN
Other - Last Name:TRUDGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1575 SPRING PLACE NW APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:859-494-4779
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53198207V00000X
DCMTL002932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology