MEDICARE: DR. AIMEE S PARK M.D.

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	207RC0000X	Cardiovascular Disease Physician	D0062352	MD

General Provider Information

NPI Number	:	1265435978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIMEE S PARK M.D.

Provider Business Mailing Address
First Line	:	180 THOMAS JOHNSON DRIVE
Second Line	:	SUITE 202
City	:	FREDERICK
State	:	MD
Zip	:	21702-4550
Country	:	US
Telephone Number	:	301-631-6877
Fax Number	:	240-566-7820

Provider Business Practice Location Address
First Line	:	180 THOMAS JOHNSON DR
Second Line	:	STE 202
City	:	FREDERICK
State	:	MD
Zip	:	21702-4409
Country	:	US
Telephone Number	:	301-631-6877
Fax Number	:	240-566-7820

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/07/2022

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Directions to “ DR. AIMEE S PARK M.D.” Practice Location

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