Healthcare Provider Details

I. General information

NPI: 1851615512
Provider Name (Legal Business Name): RACHEL DOROTHY SPARKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR RM 12C103, MSC 1899
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DR RM 12C103, MSC 1899
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-402-2162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD042109
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD75957
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: