Healthcare Provider Details

I. General information

NPI: 1235063579
Provider Name (Legal Business Name): SPARKS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S ATWOOD RD STE 207A
BEL AIR MD
21014-4172
US

IV. Provider business mailing address

602 S ATWOOD RD STE 207A
BEL AIR MD
21014-4172
US

V. Phone/Fax

Practice location:
  • Phone: 410-223-2616
  • Fax: 800-574-5154
Mailing address:
  • Phone: 410-223-2616
  • Fax: 800-574-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELANIE ROWE SPARKS
Title or Position: PRESIDENT
Credential: FNP
Phone: 410-223-2616