Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD-060603-L | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD060603L | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD060603L | PA |
N | 207V00000X | Obstetrician & Gynecologist | MD-060603-L | PA |
NPI | 1457378028 |
---|---|
Provider Name | Dr. Susan M. Parks |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 10/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001719355 | (05) | PA |
0052949 | (05) | NJ |