Provider Demographics
NPI:1467638189
Name:IRA SPAR, MDPC
Entity Type:Organization
Organization Name:IRA SPAR, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUSCHILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-628-8789
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0477940001Medicare NSC