Chan M Park (NPI# 1457467037, PAC ID# 8628109360) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1457467037 |
| PAC ID by PECOS | 8628109360 |
| Professional Enrollment ID | I20100624000753 |
| Full Name | Chan M Park |
| Address |
6460 Greensboro Rd Ridgeway VA 24148-3478 |
| Phone Number | 2769562047 |
| Gender | M |
| Medical School | UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE |
| Graduation Year | 1996 |
| Primary Specialty | FAMILY MEDICINE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490075 | SOVAH HEALTH DANVILLE |
| 340060 | MOREHEAD MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 6460 Greensboro Rd, Ridgeway, VA 24148-3478 | 2769562047 |
| Street Address |
6460 GREENSBORO RD |
| City | RIDGEWAY |
| State | VA |
| Zip | 24148-3478 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Makunda Abdul-mbacke | Obstetrics/gynecology | 6890 Greensboro Rd, Ridgeway, VA 24148-3555 |
| City | RIDGEWAY |
| Zip Code | 24148 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | RIDGEWAY + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Chan M Park.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.