Provider Demographics
NPI:1295730521
Name:PARK, ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
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 1:10902 SUGARBUSH TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:202-291-4130
Practice Address - Street 1:8630 FENTON ST STE 514
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3833
Practice Address - Country:US
Practice Address - Phone:301-587-1220
Practice Address - Fax:301-587-1269
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061228207W00000X
DCMD034716207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036027400Medicaid
DC013737M09Medicare ID - Type Unspecified
102990Medicare UPIN