Healthcare Provider Details

I. General information

NPI: 1992752638
Provider Name (Legal Business Name): DANA P B SPARHAWK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 POST RD SUITE 3
WARWICK RI
02886-1532
US

IV. Provider business mailing address

2191 POST RD SUITE 3
WARWICK RI
02886-1532
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-8100
  • Fax:
Mailing address:
  • Phone: 401-738-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number57653
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: