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NPI Code Detail

MEDICARE: MR. PETER DONGSHIK PARK MD

MEDICARE: MR. PETER DONGSHIK 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
1207RG0100XGastroenterology PhysicianD0047827MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689636078
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER DONGSHIK PARK MD
Provider Business Mailing Address
First Line : 510 UPPER CHESAPEAKE DR
Second Line : SUITE 416
City : BEL AIR
State : MD
Zip : 21014-4328
Country : US
Telephone Number : 443-643-4700
Fax Number : 443-643-4707
Provider Business Practice Location Address
First Line : 510 UPPER CHESAPEAKE DR STE 416
Second Line :
City : BEL AIR
State : MD
Zip : 21014-4336
Country : US
Telephone Number : 443-643-4700
Fax Number : 443-643-4707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 10/08/2019

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