MEDICARE: EUGENE L 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	208800000X	Urology Physician	0101247088	VA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992707137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE L PARK MD

Provider Business Mailing Address
First Line	:	8580 MAGELLAN PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-765-6100
Fax Number	:	804-765-6101

Provider Business Practice Location Address
First Line	:	40 MEDICAL PARK BLVD STE D
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805
Country	:	US
Telephone Number	:	804-765-6100
Fax Number	:	804-765-6101

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/05/2020

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