MEDICARE: KATHRYN L SPARHAWK MD

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	207Q00000X	Family Medicine Physician	0101035541	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	025510	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659379774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN L SPARHAWK MD

Provider Business Mailing Address
First Line	:	4830 RUCKER RD
Second Line	:
City	:	MONETA
State	:	VA
Zip	:	24121-5281
Country	:	US
Telephone Number	:	540-297-7181
Fax Number	:	540-297-6145

Provider Business Practice Location Address
First Line	:	4830 RUCKER RD
Second Line	:
City	:	MONETA
State	:	VA
Zip	:	24121-5281
Country	:	US
Telephone Number	:	540-297-7181
Fax Number	:	540-297-6145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/07/2023

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