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NPI Code Detail

MEDICARE: ELAINE PARK

MEDICARE: ELAINE 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1083563621
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELAINE PARK
Provider Business Mailing Address
First Line : 150 BEE ST APT 502
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-5704
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 171 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8908
Country : US
Telephone Number : 843-792-1414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2026
Last Update Date : 01/27/2026

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Directions to “ ELAINE PARK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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