Chan Park MD Inc
Organization Active NPI Family Medicine Physician · Slatersville, RI
NPI 1104865849 · NPPES record last updated Feb 26, 2008
Key facts
- NPI
- 1104865849
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD5083 (RI)
- Legal business name
- CHAN PARK MD INC
- Practice address
- 905 Victory Highway
Slatersville, RI 02876 - Phone
- (401) 762-2728
- Fax
- (401) 762-0473
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Chan Hoon Park, MD
- Title
- Owner
- Phone
- (401) 762-2728
Practitioners 5
-
John F Biernacki, DMD
-
Guy M Boulay, C.A.G.S.
-
Robert Joseph Sclama Jr., MSPT
-
Craig Anthony Simpson, M.S., P.T.
-
Mark D. Schenkman, D.D.S.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | MD5083 | RI | Yes |
Addresses
Primary practice location
905 Victory Highway
Slatersville, RI 02876
Mailing address
PO Box 177
905 Victory Hwy
Slatersville, RI 02876
Phone (401) 762-2728
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12601 | Other | RI | BLUE CROSS BLUE SHIELD |
| 9001260 | Medicaid | RI | |
| 001727 | Other | RI | BCBS BLUE CHIP |
| 404332 | Other | TUFTS | |
| AA26737 | Other | HAVARD PILGRIM | |
| 0101561 | Other | MA | EVERCARE |
| 0100118 | Other | UNITED HEALTHCARE |
Other providers in Slatersville, RI
- Emily Jane Ackerman
- Comprehensive Physical Therapy
- Dental Associates of No. Smithfield, PC
- Amy Lee Glaude-Marcos
- Lauren Helena Herring
- Inner Light Counseling & Wellness, LLC
All providers in Slatersville, RI · Family Medicine Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.