Healthcare Provider Details

I. General information

NPI: 1508229832
Provider Name (Legal Business Name): JEAN PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 LORD BALTIMORE DR STE 103
BALTIMORE MD
21244-2644
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 410-277-3937
  • Fax: 410-281-9388
Mailing address:
  • Phone: 667-354-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberD0091817
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: