Provider Demographics
NPI:1962482240
Name:PARK, JAE MU (MD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:MU
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2206 MOUNT HEBRON CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1809
Mailing Address - Country:US
Mailing Address - Phone:410-465-0409
Mailing Address - Fax:410-465-6154
Practice Address - Street 1:6655 SYKESVILLE RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7966
Practice Address - Country:US
Practice Address - Phone:410-970-7000
Practice Address - Fax:410-970-7024
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDD00207552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID77799Medicare UPIN