Provider Demographics
NPI:1508207473
Name:RICHARD D SPARROW
Entity Type:Organization
Organization Name:RICHARD D SPARROW
Other - Org Name:RICHARD D SPARROW DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-310-6938
Mailing Address - Street 1:3517 KENT RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4601
Mailing Address - Country:US
Mailing Address - Phone:330-310-6938
Mailing Address - Fax:
Practice Address - Street 1:116 EAST AVE
Practice Address - Street 2:STE 4
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2300
Practice Address - Country:US
Practice Address - Phone:330-310-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002144-S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4280847OtherAETNA
OH000000165800OtherANTHEM
OH0561691Medicaid
OH470275OtherUNITED HEALTHCARE
OH480003267OtherRAILROAD MEDICARE
OH=========-001OtherMEDICAL MUTUAL OF OHIO
OH480003267OtherRAILROAD MEDICARE
OH0561691Medicaid