Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 0102201078 | VT |
N | 207RC0200X | Critical Care Medicine | 650 | SC |
N | 207RP1001X | Pulmonary Disease | 0102201078 | VA |
N | 207RP1001X | Pulmonary Disease | 650 | SC |
N | 207RS0012X | Sleep Medicine | 0102201078 | VA |
N | 207RS0012X | Sleep Medicine | 650 | SC |
NPI | 1033275805 |
---|---|
Provider Name | Dr. Edward S Pak |
First Address | Williamsburg, VA 23185-8935 |
Second Address | Newport News, VA 23601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 06/08/2018 |