Individual
JUSTIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 CRAIN HWY S, SUITE 401, GLEN BURNIE, MD 21061-5577
(410) 768-5050
(410) 768-7830
Mailing address
1600 CRAIN HWY S, SUITE 401, GLEN BURNIE, MD 21061-5577
(410) 768-5050
(410) 768-7830
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
43955
KY
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
D0073546
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231508400
—
MD
01
—
253616
JHHC
MD
01
—
6029607
CIGNA
MD
01
—
6831-0019
CAREFIRST
MD
01
—
8543972
AETNA HMO
MD
01
—
9804676
AETNA PPO
MD
01
—
K007170
MEDICARE PTAN-- NORTON LEATHERMAN SPINE
KY
Enumeration date
08/25/2007
Last updated
04/15/2013
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