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General NPI Number Information
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NPI Number | 1457354979
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Entity Type | Individual
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Provider Name | RICHARD D SPARROW DPM
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Gender | Male
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 116 EAST AVE STE 4
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City | TALLMADGE
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State | OH
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Zip | 44278-2328
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Country | US
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Telephone | 330-310-6938
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Fax | 330-633-6028
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Provider Business Mailing Address
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Address Line | 3517 KENT RD
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City | STOW
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State | OH
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Zip | 44224-4601
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Country | US
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Telephone | 330-310-6938
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Fax | 330-688-4241
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36-002144-S
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License Number State | OH
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