Basic Information
| Provider Information | |||||||||
| NPI: | 1306102157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | CHANTEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 WALNUT ST STE 805 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159558768 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 S 9TH ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191076810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159558430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | MD460654 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.