Organization
CHAN PARK MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAN HOON PARK MD (OWNER)
(401) 762-2728
Entity
Organization
Contact information
Practice address
905 VICTORY HIGHWAY, SLATERSVILLE, RI 02876
(401) 762-2728
(401) 762-0473
Mailing address
PO BOX 177, 905 VICTORY HWY, SLATERSVILLE, RI 02876
(401) 762-2728
(401) 762-0473
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD5083
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001727
BCBS BLUE CHIP
RI
01
—
0100118
UNITED HEALTHCARE
—
01
—
0101561
EVERCARE
MA
01
—
12601
BLUE CROSS BLUE SHIELD
RI
01
—
404332
TUFTS
—
05
—
9001260
—
RI
01
—
AA26737
HAVARD PILGRIM
—
Enumeration date
06/06/2006
Last updated
02/26/2008
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