=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407896244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MARK SPARGO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3949 BROWNING PL
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-787-8221
-----------------------------------------------------
Fax | 919-789-4462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1825855
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19182-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-658-9118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 38207
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------