Individual
CHARLES C PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 ST. PAUL PLACE, POB # 310, BALTIMORE, MD 21202
(410) 332-9872
(410) 659-1172
Mailing address
301 ST. PAUL PLACE, MEDICAL STAFF OFFICE, BALTIMORE, MD 21202-2102
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
D0051977
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
388700600
—
MD
01
—
BU53/0001
CAREFIRST
MD
Enumeration date
06/21/2006
Last updated
05/31/2016
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