Individual
CHAN M PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6460 GREENSBORO RD, RIDGEWAY, VA 24148-3478
(276) 956-2047
(276) 956-1637
Mailing address
6460 GREENSBORO RD, RIDGEWAY, VA 24148-3478
(276) 956-2047
(276) 956-1637
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101229138
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005372768
AETNA
—
05
—
010011019
—
VA
01
—
2108815
MAMSI
—
01
—
3506280
CIGNA
—
01
—
463669
ANTHEM, BCBS OF VIRGINIA
VA
01
—
A1738
MEDCOST PREFERRED
—
Enumeration date
08/23/2006
Last updated
07/08/2007
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