Healthcare Provider Details

I. General information

NPI: 1316984776
Provider Name (Legal Business Name): DAVID DOUGLASS SPRAGG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64250
BALTIMORE MD
21264-4250
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3097
  • Fax:
Mailing address:
  • Phone: 410-502-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberP16193
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberD64724
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: