Provider Demographics
NPI:1578833851
Name:SPARKS, EDWARD DELANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DELANCY
Last Name:SPARKS
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 1:1135 ONTARIO CT
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8197
Mailing Address - Country:US
Mailing Address - Phone:937-492-7905
Mailing Address - Fax:937-492-7905
Practice Address - Street 1:1135 ONTARIO CT
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8197
Practice Address - Country:US
Practice Address - Phone:937-492-7905
Practice Address - Fax:937-492-7905
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 027519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine