Provider Demographics
NPI:1013933837
Name:PARK, NANCY H (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:H
Last Name:PARK
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 1:993 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2331
Mailing Address - Country:US
Mailing Address - Phone:412-264-1918
Mailing Address - Fax:412-749-6781
Practice Address - Street 1:993 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2331
Practice Address - Country:US
Practice Address - Phone:412-264-1918
Practice Address - Fax:412-262-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031618E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010612800002Medicaid
C29175Medicare UPIN
PA0010612800002Medicaid