Provider Demographics
NPI:1124020516
Name:SPARKS, MAURA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:L
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:372 DANBURY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2523
Mailing Address - Country:US
Mailing Address - Phone:203-276-4015
Mailing Address - Fax:203-834-2639
Practice Address - Street 1:372 DANBURY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2523
Practice Address - Country:US
Practice Address - Phone:203-276-4015
Practice Address - Fax:203-834-2639
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT045756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110010396Medicare PIN
CT004187466Medicaid