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General NPI Number Information
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NPI Number | 1669701868
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Entity Type | Organization
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Legal Business Name | I. JAMES PARK, M.D., P.A.
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 5601 LOCH RAVEN BLVD SUITE 400
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City | BALTIMORE
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State | MD
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Zip | 21239-2905
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Country | US
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Telephone | 410-583-7670
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Fax | 410-583-7671
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Provider Business Mailing Address
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Address Line | PO BOX 9819
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City | BALTIMORE
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State | MD
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Zip | 21284-9819
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Country | US
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Telephone | 410-583-7670
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Fax | 410-583-7671
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IN JOO JAMES PARK
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Credential | M.D.
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Telephone | 410-583-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D0004802
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License Number State | MD
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