Provider Demographics
NPI:1093892101
Name:SPOSATO, RICHARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:SPOSATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 VAN DORN ST
Mailing Address - Street 2:1B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2842
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:
Practice Address - Street 1:6920 VAN DORN ST
Practice Address - Street 2:1B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2842
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB90773Medicare UPIN