Healthcare Provider Details

I. General information

NPI: 1174968838
Provider Name (Legal Business Name): CATHERINE PARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

611 N PEGRAM ST
ALEXANDRIA VA
22304-2727
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD048441
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: