MEDICARE: DR. KHRISTINE A SPARTA DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	878	CT
2	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00307100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295850204	OTHER	CT	ASSOCIATED PODIATRISTS OF NORTH HAVEN, LLC GROUP NPI
2	25MD00307100	OTHER	NJ	NJ LICENCE
3	1700985835	OTHER	CT	ASSOCIATED PODIATRISTS OF FAIRFIELD, LLC GROUP NPI

General Provider Information

NPI Number	:	1700038858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHRISTINE A SPARTA DPM

Provider Business Mailing Address
First Line	:	1881 POST RD
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-5721
Country	:	US
Telephone Number	:	908-337-1969
Fax Number	:	203-259-3444

Provider Business Practice Location Address
First Line	:	83 WASHINGTON AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-1704
Country	:	US
Telephone Number	:	203-787-3800
Fax Number	:	203-787-0004

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	01/17/2013

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