Healthcare Provider Details

I. General information

NPI: 1255514469
Provider Name (Legal Business Name): DOUGLAS MICHAEL SPROULE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE FL 5 HARKNESS PAVILION, COLUMBIA-PRESBYTERIAN MEDICAL CENTER
NEW YORK NY
10032-3735
US

IV. Provider business mailing address

180 FORT WASHINGTON AVE FL 5 HARKNESS PAVILION, COLUMBIA-PRESBYTERIAN MEDICAL CENTER
NEW YORK NY
10032-3735
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-3679
  • Fax:
Mailing address:
  • Phone: 212-342-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number236824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: