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NPI Code Detail

MEDICARE: SYLVIA PARK MD

MEDICARE: SYLVIA 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
12084P0800XPsychiatry PhysicianMD23677ME
22084P0800XPsychiatry Physician24336NH

General Provider Information

NPI Number : 1962716571
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYLVIA PARK MD
Provider Business Mailing Address
First Line : 53 BAXTER BLVD STE 3
Second Line :
City : PORTLAND
State : ME
Zip : 04101-1827
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 53 BAXTER BLVD STE 3
Second Line :
City : PORTLAND
State : ME
Zip : 04101-1827
Country : US
Telephone Number : 207-613-4115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2010
Last Update Date : 02/27/2026

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Directions to “ SYLVIA PARK MD” Practice Location

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