Provider Demographics
NPI:1518961986
Name:SPARAGNA, ANGELO III (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:SPARAGNA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2060
Mailing Address - Country:US
Mailing Address - Phone:609-927-1163
Mailing Address - Fax:609-927-3909
Practice Address - Street 1:425 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2060
Practice Address - Country:US
Practice Address - Phone:609-927-1163
Practice Address - Fax:609-927-3909
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA23948OtherSTATE LICENSE
NJ04575AMTMedicare PIN
NJD06874Medicare UPIN