Individual
LINDA PARK NIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
243 CHURCH ST NW, SUITE 200 C, VIENNA, VA 22180-4434
(703) 938-5700
(703) 938-4467
Mailing address
PO BOX 79262, BALTIMORE, MD 21279-0262
(703) 938-5700
(703) 938-4467
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
0101028419
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G00477
GROUP MEDICARE PIN
VA
Enumeration date
06/29/2005
Last updated
03/29/2008
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