Provider Demographics
NPI:1619002508
Name:PARKS, SUKI LILLIANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUKI
Middle Name:LILLIANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:SUKI
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:DEPARTMENT RADIATION ONCOLOGY, MT PLEASANT, GRND
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5405
Mailing Address - Fax:410-601-6307
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:DEPARTMENT RADIATION ONCOLOGY, MT PLEASANT, GRND
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-5405
Practice Address - Fax:410-601-6307
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S99873Medicare UPIN