Provider Demographics
NPI:1326089392
Name:PARKE, J. WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:WILLIAM
Last Name:PARKE
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 1:2 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1546
Mailing Address - Country:US
Mailing Address - Phone:717-285-3144
Mailing Address - Fax:
Practice Address - Street 1:2 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1546
Practice Address - Country:US
Practice Address - Phone:717-285-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021078E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000723578Medicaid
PAD71287Medicare UPIN
PA146914Medicare ID - Type Unspecified