MEDICARE: DR. SAE-YOON SHARON PARK MD

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	207Q00000X	Family Medicine Physician	D92535	MD

General Provider Information

NPI Number	:	1265927321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAE-YOON SHARON PARK MD

Provider Business Mailing Address
First Line	:	3400 BOX HILL CORPORATE CENTER DR STE 100
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1290
Country	:	US
Telephone Number	:	410-515-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BOX HILL CORPORATE CENTER DR STE 100
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1290
Country	:	US
Telephone Number	:	800-777-7904
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	03/22/2022

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