Provider Demographics
NPI:1285753160
Name:VIRGILIO, COURTNEY RAE (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:RAE
Last Name:VIRGILIO
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:RAE
Other - Last Name:TSOURMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 NW 11TH ST STE E23
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8603
Mailing Address - Country:US
Mailing Address - Phone:541-289-4120
Mailing Address - Fax:
Practice Address - Street 1:600 NW 11TH ST STE E23
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8603
Practice Address - Country:US
Practice Address - Phone:541-667-3771
Practice Address - Fax:541-303-8457
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD179426207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD179426OtherOREGON LICENSE