Provider Demographics
NPI:1548238298
Name:SPARE, JOSEPH TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TIMOTHY
Last Name:SPARE
Suffix:
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 1:125 EXECUTIVE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6302
Mailing Address - Country:US
Mailing Address - Phone:740-387-3087
Mailing Address - Fax:740-382-5034
Practice Address - Street 1:125 EXECUTIVE DR STE 201
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6302
Practice Address - Country:US
Practice Address - Phone:740-387-3087
Practice Address - Fax:740-382-5034
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0365822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256229Medicaid
OH0256229Medicaid
0416584Medicare ID - Type Unspecified