Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 244859 | NY |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101247548 | VA |
NPI | 1134387889 |
---|---|
Provider Name | Joseph S. Park |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22903-7851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 26/08/2010 |