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Individual

COURTNEY MARIE PORT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O

Contact information

Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042
(703) 776-6652
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(202) 321-4151

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0102203284
VA
208000000X
Pediatrics Physician
0116021679
VA
208M00000X
Hospitalist Physician
0102203284
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0102203284
VA
Enumeration date
06/15/2009
Last updated
08/19/2021
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