Provider Demographics
NPI:1558744359
Name:COURTER, ELLIOTT BRADLEY (DO)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:BRADLEY
Last Name:COURTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3370
Mailing Address - Country:US
Mailing Address - Phone:704-825-5333
Mailing Address - Fax:
Practice Address - Street 1:1220 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3370
Practice Address - Country:US
Practice Address - Phone:704-825-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03835207Q00000X
SC37685207V00000X
CODR.0061735390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology