Provider Demographics
NPI:1568810174
Name:DETWILER, COURTNEY ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELLEN
Last Name:DETWILER
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 1:101 MANNING DRIVE HOSPITAL MEDICINE CB#7085
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7085
Mailing Address - Country:US
Mailing Address - Phone:919-423-2753
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE HOSPITAL MEDICINE CB #7085
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-3219
Practice Address - Country:US
Practice Address - Phone:919-423-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219555207R00000X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program