MEDICARE: SPARKS MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1235063579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKS MEDICAL LLC

Provider Business Mailing Address
First Line	:	602 S ATWOOD RD STE 207A
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-4172
Country	:	US
Telephone Number	:	410-223-2616
Fax Number	:	800-574-5154

Provider Business Practice Location Address
First Line	:	602 S ATWOOD RD STE 207A
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-4172
Country	:	US
Telephone Number	:	410-223-2616
Fax Number	:	800-574-5154

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELANIE ROWE SPARKS
Credential	:	FNP
Telephone Number	:	410-223-2616

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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