Healthcare Provider Details

I. General information

NPI: 1912134503
Provider Name (Legal Business Name): ASHA ROBINSON-PARKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S CLEARVIEW PKWY
JEFFERSON LA
70121-1011
US

IV. Provider business mailing address

9224 EDWARDS WAY APT 3106
HYATTSVILLE MD
20783-3429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4025
  • Fax:
Mailing address:
  • Phone: 202-375-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDC039779
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD83055
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number324174
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: