MEDICARE: SUN PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD423408	PA

General Provider Information

NPI Number	:	1043213663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUN PARK

Provider Business Mailing Address
First Line	:	11279 PERRY HWY
Second Line	:	STE 450
City	:	WEXFORD
State	:	PA
Zip	:	15090-9303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 FORT COUCH RD
Second Line	:	SUITE 100
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-1042
Country	:	US
Telephone Number	:	412-831-1114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/25/2021

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Directions to “ SUN PARK ” Practice Location

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