Individual
JENNIFER PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8001 FORBES PL, SUITE 103, SPRINGFIELD, VA 22151-2208
(703) 824-3200
Mailing address
PO BOX 79537, BALTIMORE, MD 21279-0537
(703) 824-3200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101230581
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00283101
COMPUTED TOMOGRAPHY ASSOCIATES, RR MEDICARE
—
01
—
P00284587
RAILROAD MEDICARE
—
Enumeration date
09/27/2006
Last updated
03/25/2013
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