JUSTIN PARK (NPI# 1265625941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265625941 |
| Entity Type | Individual |
| Full Name | JUSTIN PARK |
| Credential | M.D. |
| Practice Address |
1600 Crain Hwy S Suite 401 Glen Burnie MD 21061-5577 |
| Practice Telephone | 4107685050 |
| Practice Fax Number | 4107687830 |
| Mailing Telephone | 4107685050 |
| Mailing Fax Number | 4107687830 |
| Enumeration Date | 2007-08-25 |
| Last Update Date | 2013-04-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
D0073546 | MD | Allopathic & Osteopathic Physicians |
| N | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
43955 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 231508400 | 05 | |
| MD | CAREFIRST | 6831-0019 | 01 |
| KY | MEDICARE PTAN-- NORTON LEATHERMAN SPINE | K007170 | 01 |
| MD | JHHC | 253616 | 01 |
| MD | CIGNA | 6029607 | 01 |
| MD | AETNA HMO | 8543972 | 01 |
| MD | AETNA PPO | 9804676 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225536816 | Justin Joonhyuk Park | Student in an Organized Health Care Education/Training Program | 1044 N Francisco Ave, Gme Office, Chicago, IL 60622-2743 | 2018-01-29 |
| 1356867477 | Justin Park | Counselor | 6013 S Redwood Rd, Taylorsville, UT 84123-5220 | 2017-08-21 |
| 1780075416 | Justin Park | Student in an Organized Health Care Education/Training Program | 240 E Huron St, Suite 1-200, Chicago, IL 60611-2909 | 2015-02-17 |
| Street Address |
1600 CRAIN HWY S SUITE 401 |
| City | GLEN BURNIE |
| State | MD |
| Zip Code | 21061-5577 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194721753 | Michael John Daly | Pain Medicine | 1600 Crain Hwy S, Suite 301, Glen Burnie, MD 21061-5577 | 2005-06-28 |
| 1144884909 | Aisha Zareen | Physical Therapist | 1600 Crain Hwy S, Glen Burnie, MD 21061-5577 | 2019-04-26 |
| 1184196024 | Courtney Keegan Perkins | Nurse Practitioner | 1600 Crain Hwy S, Glen Burnie, MD 21061-5577 | 2018-12-17 |
| 1003383779 | Sanchez Brown | Nurse Practitioner | 1600 Crain Hwy S, Glen Burnie, MD 21061-5577 | 2018-10-30 |
| 1306357595 | Kia Ahmed | Nurse Practitioner | 1600 Crain Hwy S, Glen Burnie, MD 21061-5577 | 2017-10-16 |
| 1326571415 | Kimberly Layton Rice | Nurse Practitioner | 1600 Crain Hwy S, Suite 201, Glen Burnie, MD 21061-5577 | 2017-04-06 |
| 1871044834 | Megan Fredricks Cocco | Counselor | 1600 Crain Hwy S, Suite 503, Glen Burnie, MD 21061-5577 | 2016-10-14 |
| 1275083461 | All Star Pain Management and Regenerative Medicine, LLC | Physical Medicine & Rehabilitation | 1600 Crain Hwy S, Suite 206, Glen Burnie, MD 21061-5577 | 2016-10-11 |
| 1528517307 | Maryland Sportscare & Rehab, LLC | Physical Therapist | 1600 Crain Hwy S, 302, Glen Burnie, MD 21061-5577 | 2016-09-22 |
| 1194270959 | Ashley Nicole Fogarty | Physical Therapist | 1600 Crain Hwy S, Suite 302, Glen Burnie, MD 21061-5577 | 2016-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255814422 | Lotus Behavioral Health and Rehabilitation Services Inc. | Behavior Technician | 6426 Harrison Square, Glen Burnie, MD 21061 | 2018-09-12 |
| 1942795315 | Tina Brown | Behavior Technician | Rise for Autism, 510 Mccormick Drive, Ste. U-w, Glen Burnie, MD 21061 | 2018-06-27 |
| 1205351905 | Digna Emerita Sanchez De Vasquez | Specialist/Technologist, Other | 201 Fernglen Ave, Glen Burnie, MD 21061 | 2017-08-03 |
| 1255780300 | Rachel Cutts | Physical Therapist | 7711 Quarterfield Rd Ste C2, Glen Burnie, MD 21061 | 2016-06-09 |
| 1295181170 | Gaudenzia, Inc. | Counselor | 5 Crain Highway North - Rear Suite Entrance, Glen Burnie, MD 21061 | 2016-05-10 |
| 1023499548 | Mary Bourbon | Nurse Practitioner | 1600 S. Cain Highway, Suite 401, Glen Burnie, MD 21061 | 2015-06-10 |
| 1972997724 | Robert Oladeinde | Physician Assistant | 6934 Aviation Blvd Suite B, Glen Burnie, MD 21061 | 2015-03-18 |
| 1205248069 | Cathy Qing He | Anesthesiology | 1600 Crain Hwy S Ste 301, Glen Burnie, MD 21061 | 2014-05-28 |
| 1477974764 | Shannon Holder | Nurse Practitioner | 1916 Crain Hwy S Ste 2, Glen Burnie, MD 21061 | 2014-01-03 |
| 1629404207 | Marla Ann Muha | Physician Assistant | 301 Hospital Dr # 803, Glen Burnie, MD 21061 | 2013-09-16 |
| Find all providers in zip 21061 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134767643 | Mohammad Mofreh S Altaleb | Orthopaedic Surgery | 601 North Caroline Street / Rm 5223, Baltimore, MD 21287-0882 | 2019-12-16 |
| 1598273849 | Joint Replacement Cin of Dc LLC | Orthopaedic Surgery | 1 Research Ct Ste 450b, Rockville, MD 20850-3221 | 2018-01-19 |
| 1386152262 | Spine Cin of Dc LLC | Orthopaedic Surgery | 1 Research Ct Ste 450a, Rockville, MD 20850-3221 | 2018-01-13 |
| 1497020960 | Peter Dean Landin | Orthopaedic Surgery | 523 S Washington St, Easton, MD 21601-2826 | 2012-03-17 |
| 1396842324 | Jose Bigol Corvera | Orthopaedic Surgery | 9 Fox Knoll Ct, Timonium, MD 21093-2847 | 2006-09-20 |
| 1215956529 | Randy Frank Davis | Orthopaedic Surgery | 3500 Boston St Ste J2, Baltimore, MD 21224-5251 | 2006-07-18 |
| 1023071206 | Said Goto Osman | Orthopaedic Surgery | 1003 W 7th St Ste 503, Frederick, MD 21701-8512 | 2006-04-10 |
| 1376510446 | Benjamin N Carr | Orthopaedic Surgery | 2700 Quarry Lake Dr #300, Baltimore, MD 21209-3746 | 2006-03-07 |
| 1194230383 | Advanced Pain Management, LLC | Orthopaedic Surgery | 1050 Key Pkwy Ste 103, Frederick, MD 21702 | 2017-12-10 |
| 1326583006 | Advanced Spine Endoscopy and Pain Institute | Orthopaedic Surgery | 1003 W 7th St Ste 503, Frederick, MD 21701-8512 | 2017-01-04 |
| Find all providers with the same taxonomy | ||||
| City | GLEN BURNIE |
| Zip Code | 21061 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.