Provider Demographics
NPI:1609872134
Name:SPERRAZZA, RALPH C (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:C
Last Name:SPERRAZZA
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 1:4510 MAIN ST
Mailing Address - Street 2:FL 2
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3800
Mailing Address - Country:US
Mailing Address - Phone:716-839-3057
Mailing Address - Fax:716-839-1477
Practice Address - Street 1:4510 MAIN ST
Practice Address - Street 2:FL 2
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3800
Practice Address - Country:US
Practice Address - Phone:716-839-3057
Practice Address - Fax:716-839-1477
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY119764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB71573Medicare UPIN
NYBB5316Medicare ID - Type Unspecified