Individual
MICAH J PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19420 GOLF VISTA PLZ STE 250, LANSDOWNE, VA 20176-8267
(804) 207-6737
(703) 665-7686
Mailing address
4800 N SCOTTSDALE RD STE 2500, SCOTTSDALE, AZ 85251-7630
(804) 207-6737
(703) 665-7686
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101281727
VA
2084P0800X
Psychiatry Physician
MD210011823
DC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/27/2020
Last updated
04/29/2026
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