Provider Demographics
NPI:1275526477
Name:PARK, CHONG S (MD)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:S
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:STE 504
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-469-7900
Mailing Address - Fax:412-469-7919
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:STE 504
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-469-7900
Practice Address - Fax:412-469-7919
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-053162-L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016361900003Medicaid
PA900253QTZMedicare ID - Type Unspecified
PA0016361900003Medicaid