Healthcare Provider Details

I. General information

NPI: 1700206869
Provider Name (Legal Business Name): JOSEPH CHOI PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 07/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LANDMARK DR. STE 119
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

802 LANDMARK DR STE 119
GLEN BURNIE MD
21061
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8840
  • Fax: 410-367-2464
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD87505
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: