Provider Demographics
NPI:1205983004
Name:PARK, DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:PARK
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 1:4954 N. PALMER ROAD
Mailing Address - Street 2:BUILDING 19, ROOM 3656
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889
Mailing Address - Country:US
Mailing Address - Phone:301-319-2100
Mailing Address - Fax:301-319-2119
Practice Address - Street 1:4954 N PALMER RD RM 3656
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-3455
Practice Address - Country:US
Practice Address - Phone:301-319-2100
Practice Address - Fax:301-319-2119
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063363A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN146470D2OtherMEDICARE PROVIDER NUMBER
IN200861710Medicaid
IN146470D2OtherMEDICARE PROVIDER NUMBER