Provider Demographics
NPI:1346207990
Name:SPAR, IRA LAWRENCE (MDPC)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:LAWRENCE
Last Name:SPAR
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1538
Mailing Address - Country:US
Mailing Address - Phone:860-628-8789
Mailing Address - Fax:860-628-9863
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1538
Practice Address - Country:US
Practice Address - Phone:860-628-8789
Practice Address - Fax:860-628-9863
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017525207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1175256Medicaid
CT0477940001Medicare NSC
CTB83364Medicare UPIN