Healthcare Provider Details

I. General information

NPI: 1013933837
Provider Name (Legal Business Name): NANCY H PARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 MIDDLE ST
PITTSBURGH PA
15212-4915
US

IV. Provider business mailing address

816 MIDDLE ST
PITTSBURGH PA
15212-4915
US

V. Phone/Fax

Practice location:
  • Phone: 412-321-4001
  • Fax: 412-321-4063
Mailing address:
  • Phone: 412-321-4001
  • Fax: 412-321-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD031618E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: