Healthcare Provider Details

I. General information

NPI: 1023044930
Provider Name (Legal Business Name): MICHAEL B SPARKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5155
  • Fax: 603-650-2097
Mailing address:
  • Phone: 603-650-5155
  • Fax: 603-650-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10404
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: