Healthcare Provider Details

I. General information

NPI: 1376922682
Provider Name (Legal Business Name): HANNAH PARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 211
VOORHEES NJ
08043-4504
US

IV. Provider business mailing address

2301 E EVESHAM RD STE 211
VOORHEES NJ
08043-4504
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-7392
  • Fax: 856-455-3373
Mailing address:
  • Phone: 856-783-7392
  • Fax: 856-455-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11672500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: