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NPI Code Detail

MEDICARE: DR. CHARLIE PARK

MEDICARE: DR. CHARLIE 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
2122300000XDentistDS038502PA

General Provider Information

NPI Number : 1598932212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLIE PARK
Provider Business Mailing Address
First Line : 401 COMMERCE DR
Second Line : SUITE 108
City : FT WASHINGTON
State : PA
Zip : 19034-2714
Country : US
Telephone Number : 267-460-4254
Fax Number :
Provider Business Practice Location Address
First Line : 401 COMMERCE DR
Second Line : SUITE 108
City : FT WASHINGTON
State : PA
Zip : 19034-2714
Country : US
Telephone Number : 267-460-4254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2008
Last Update Date : 03/05/2012

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Directions to “ DR. CHARLIE PARK ” Practice Location

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