Provider Demographics
NPI:1154769966
Name:JOSEPH, COURTNEY MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SULGRAVE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3650
Mailing Address - Country:US
Mailing Address - Phone:443-708-5856
Mailing Address - Fax:667-212-5095
Practice Address - Street 1:1501 SULGRAVE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3650
Practice Address - Country:US
Practice Address - Phone:443-708-5856
Practice Address - Fax:667-212-5095
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015002390200000X
MDH812172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program