MEDICARE: THE SPARKS GROUP, 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	174400000X	Specialist	1-062876	MD

General Provider Information

NPI Number	:	1871857623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SPARKS GROUP, LLC

Provider Business Mailing Address
First Line	:	4119 ELLIS ST
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-5756
Country	:	US
Telephone Number	:	301-219-8190
Fax Number	:

Provider Business Practice Location Address
First Line	:	3547 CARRIAGE WALK LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2052
Country	:	US
Telephone Number	:	301-219-8190
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. BEVERLY TWITTY
Credential	:	M.S.
Telephone Number	:	301-219-8190

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	06/26/2012

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Directions to “THE SPARKS GROUP, LLC ” Practice Location

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