Provider Demographics
NPI:1548212004
Name:PARK, HYE-RAN (MD)
Entity type:Individual
Prefix:
First Name:HYE-RAN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W SPROUL RD STE 224
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2033
Mailing Address - Country:US
Mailing Address - Phone:610-789-6320
Mailing Address - Fax:484-471-3917
Practice Address - Street 1:100 W SPROUL RD STE 224
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2033
Practice Address - Country:US
Practice Address - Phone:610-789-6320
Practice Address - Fax:484-471-3917
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423010207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015894400001Medicaid
6775688OtherCIGNA
7060821OtherAETNA
02191OtherHEALTH PARTNERS
2710482000OtherIBC
PA1853548OtherBLSH
30035239OtherKEYSTONE MERCY
P00367106OtherRAILROAD MEDICARE
P00367106OtherRAILROAD MEDICARE
101720EH4Medicare PIN
PA1853548OtherBLSH