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General NPI Number Information
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NPI Number | 1265673263
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Entity Type | Individual
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Provider Name | MICHELLE HORNBAKER-PARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 66 E MAIN ST 2ND AND 3RD FLOOR (PRIVATE OFFICE 303)
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City | WESTMINSTER
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State | MD
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Zip | 21157
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Country | US
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Telephone | 833-351-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 109 W 27TH ST RM 5S
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City | NEW YORK
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State | NY
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Zip | 10001-6208
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Country | US
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Telephone | 833-351-8255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2935115
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD500002318
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 55237
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101279881
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0095392
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License Number State | MD
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