Provider Demographics
NPI:1427027820
Name:PARKS, ANNALISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNALISA
Middle Name:M
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8300 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3822
Mailing Address - Country:US
Mailing Address - Phone:703-448-0885
Mailing Address - Fax:703-448-0439
Practice Address - Street 1:8300 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3822
Practice Address - Country:US
Practice Address - Phone:703-448-0885
Practice Address - Fax:703-448-0439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101233283207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE30176Medicare UPIN