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Individual

DR. TONG S PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 289-1400
(703) 289-1414
Mailing address
2730-B PROSPERITY AVENUE, FAIRFAX, VA 22031-2238
(703) 289-1400
(703) 289-1414

Taxonomy

Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
0101031580
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1434646
ECFMG
05
6717527
VA
05
6717535
VA
05
6792316
VA
Enumeration date
06/07/2006
Last updated
07/08/2007
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