Individual
AMY MARIE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7740 WASHINGTON VILLAGE DR, SUITE 100, CENTERVILLE, OH 45459-4056
(937) 531-7900
(937) 531-7901
Mailing address
7740 WASHINGTON VILLAGE DR, SUITE 100, CENTERVILLE, OH 45459-4056
(937) 531-7900
(937) 531-7901
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34010269
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000731033
ANTHEM BCBS
OH
05
—
0054534
—
OH
Enumeration date
05/09/2008
Last updated
01/06/2021
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