Provider Demographics
NPI:1588891220
Name:WARNER, COURTNEY JILL (MD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JILL
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:391 MYRTLE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3797
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:3 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8639
Practice Address - Country:US
Practice Address - Phone:518-792-7122
Practice Address - Fax:518-792-3800
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1946882086S0129X
NHRT-21362086S0129X
NY2793672086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400238463Medicare PIN