Provider Demographics
NPI:1275617979
Name:PARKS, LORINDA F (MD)
Entity Type:Individual
Prefix:
First Name:LORINDA
Middle Name:F
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 HOLLAND ST
Mailing Address - Street 2:ALJHC- CREDENTIALING DEPT.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2131
Mailing Address - Country:US
Mailing Address - Phone:585-423-5800
Mailing Address - Fax:585-423-2890
Practice Address - Street 1:480 GENESEE ST
Practice Address - Street 2:JORDAN HEALTH AT WOODWARD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611
Practice Address - Country:US
Practice Address - Phone:585-436-3040
Practice Address - Fax:585-328-3812
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048599207Q00000X
NY270175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03687890Medicaid
NY03687890Medicaid