Chan Dong Park, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

17219 Issued in WV

Practice address

1002 Sushruta Dr
Martinsburg, WV 25401-8897

Phone

(304) 263-0913

Fax

(304) 267-2917

NPI assigned

Mar 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University Healthcare Physicians, Inc.

  • Family Medicine Physician
  • Martinsburg, WV
  • NPI 1659625739

  Internal Medicine

  Medicare reassignment NPD
• University Healthcare Physicians Inc

  • Anesthesiology Physician
  • Martinsburg, WV
  • NPI 1417371329
  NPD
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1407815665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 SUSHRUTA DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254018897",
            "telephone_number": "304-263-0913",
            "fax_number": "304-267-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 SUSHRUTA DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254018897",
            "telephone_number": "304-263-0913",
            "fax_number": "304-267-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHAN",
        "middle_name": "DONG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "17219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075530000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Paniagua-Ramirez
• Ruza Papeskov
• Parasimple LLC
• Larry H Pardue, M.D.
• Jeffrey Parish, PHARMD
• Jane Gerke Park, M.D.
• Kimberly Park
• Brenda Mae Parker
• Juliana Parker
• Pamela Parker

• Internal Medicine Physician in Martinsburg, WV
• Providers in Martinsburg, WV by specialty
• Internal Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.