Provider Demographics
NPI:1578550554
Name:SPRATT, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:SPRATT
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 1:231 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1947
Mailing Address - Country:US
Mailing Address - Phone:330-788-4097
Mailing Address - Fax:330-788-4061
Practice Address - Street 1:231 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1947
Practice Address - Country:US
Practice Address - Phone:330-788-4097
Practice Address - Fax:330-788-4061
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049573S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0588092Medicaid
OH000000126547OtherANTHEM
R09200101OtherGROUP NUMBER
A15467Medicare UPIN
OH0588092Medicaid
OH080004716Medicare ID - Type UnspecifiedRAILROAD MEDICARE