Healthcare Provider Details

I. General information

NPI: 1710073366
Provider Name (Legal Business Name): DANIEL I SPRATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST SUITE 200
PORTLAND ME
04102-3166
US

IV. Provider business mailing address

39 WALLACE AVE
SOUTH PORTLAND ME
04106-6143
US

V. Phone/Fax

Practice location:
  • Phone: 207-771-5549
  • Fax: 207-771-7834
Mailing address:
  • Phone: 207-761-0650
  • Fax: 207-761-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12045
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD12045
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: