Provider Demographics
NPI:1356324263
Name:MONARI SPARKS, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MONARI SPARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:2339 ROUTE 70 W FL 2
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3315
Practice Address - Country:US
Practice Address - Phone:856-532-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07395200207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000107669OtherAMERICHOICE
NJ2265364OtherUNITED HEALTHCARE
NJP3671128OtherOXFORD
NJ1174060OtherAETNA
NJ1878143OtherCIGNA
NJ2118421000OtherAMERIHEALTH/KEYSTONE/IBC
NJ42480OtherUNIVERSITY HEALTH PLAN
NJ60022541OtherHORIZON NJ HEALTH
NJ9105701Medicaid
NJH69048Medicare UPIN
NJ9105701Medicaid
NJP3671128OtherOXFORD