Individual
DR. LISA L PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4400 UNIVERSITY DR, STUDENT UNION BUILDING 1, ROOM 2300, FAIRFAX, VA 22030-4422
(703) 993-2831
(703) 993-4365
Mailing address
4400 UNIVERSITY DR, STUDENT UNION BUILDING 1, ROOM 2300, FAIRFAX, VA 22030-4422
(703) 993-2831
(703) 993-4365
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0101250887
VA
2080A0000X
Pediatric Adolescent Medicine Physician
25MA08646300
NJ
Other
Enumeration date
05/17/2007
Last updated
01/11/2012
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