Individual
CHAN DONG PARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1002 SUSHRUTA DR, MARTINSBURG, WV 25401-8897
(304) 263-0913
(304) 267-2917
Mailing address
1002 SUSHRUTA DR, MARTINSBURG, WV 25401-8897
(304) 263-0913
(304) 267-2917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17219
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075530000
—
WV
Enumeration date
03/17/2006
Last updated
07/08/2007
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