Provider Demographics
NPI:1619174315
Name:WILCZYNSKI, COURTNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:WILCZYNSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:WILCZYNSKI
Other - Last Name:CORRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:640 S. STATE STREET
Practice Address - Street 2:BAYHEALTH EMERGENCY PHYSICIANS, ,LLC
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-6156
Practice Address - Fax:302-735-3845
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0009374207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3621073 00Medicaid
DE191044Y0DMedicare PIN