Provider Demographics
NPI:1467741884
Name:PENDLETON, COURTNEY (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NICOLLS ROAD
Mailing Address - Street 2:HSC T12 RM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:631-444-1116
Mailing Address - Fax:
Practice Address - Street 1:100 NICHOLLS ROAD HSC T12 RM 080
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71646207T00000X
MN65254207T00000X
NY304536207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery