Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35088057 | OH |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD037973 | DC |
NPI | 1053328625 |
---|---|
Provider Name | Amy Park |
First Address | Washington, DC 20010-2927 |
Second Address | Washington, DC 20010-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 06/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2673156 | (05) | OH |
I56962 | (02) | OH |