MEDICARE: JOHN I PARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD034829E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197526	OTHER		HIGHMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518006725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN I PARK M.D.

Provider Business Mailing Address
First Line	:	109 CROSSROADS ROAD
Second Line	:	SUITE 6
City	:	SCOTTDALE
State	:	PA
Zip	:	15683
Country	:	US
Telephone Number	:	724-887-7421
Fax Number	:	724-887-4145

Provider Business Practice Location Address
First Line	:	109 CROSSROADS RD
Second Line	:	SUITE 6
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2458
Country	:	US
Telephone Number	:	724-887-7421
Fax Number	:	724-887-4145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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Directions to “ JOHN I PARK M.D.” Practice Location

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