Individual
SUN M PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 60968, CHARLOTTE, NC 28260-0968
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
200000928
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127HW
BCBS
NC
05
—
89127HW
—
NC
01
—
930101192
RAILROAD
NC
05
—
Q0092H
—
SC
Enumeration date
04/12/2006
Last updated
03/17/2009
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