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NPI Code Detail

MEDICARE: DR. ROBERT INGRAM SPRAGUE MD

MEDICARE: DR. ROBERT INGRAM SPRAGUE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician0101039458VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3220020618OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2217816OTHERVAANTHEM-ATLEE RD.
4217817OTHERVAANTHEM-BREMO RD.
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6181673OTHERVAANTHEM-CENTERPOINT RD.

General Provider Information

NPI Number : 1497749493
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT INGRAM SPRAGUE MD
Provider Business Mailing Address
First Line : PO BOX 5468
Second Line :
City : MARTINSVILLE
State : VA
Zip : 24115-5468
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8260 ATLEE RD
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-1844
Country : US
Telephone Number : 804-764-6873
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 08/01/2011

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