MEDICARE: OK 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	207W00000X	Ophthalmology Physician	D0050879	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DD8163 P00253267	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	J727 0001	OTHER	DC	CAREFIRST
3	767APA 68609505	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1659306520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OK PARK MD

Provider Business Mailing Address
First Line	:	2661 RIVA RD STE 1030
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7131
Country	:	US
Telephone Number	:	667-354-5528
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 LORD BALTIMORE DR STE 103
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2644
Country	:	US
Telephone Number	:	410-277-3937
Fax Number	:	410-281-9388

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/25/2026

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Directions to “ OK PARK MD” Practice Location

Language	Start Address	Practice Location

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