Provider Demographics
NPI:1629073267
Name:SPARKS, ALFRED D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:D
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:615 W MACPHAIL RD
Mailing Address - Street 2:STE 106
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4393
Mailing Address - Country:US
Mailing Address - Phone:410-638-8900
Mailing Address - Fax:410-638-8915
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:STE 106
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4393
Practice Address - Country:US
Practice Address - Phone:410-638-8900
Practice Address - Fax:410-638-8915
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD39889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD060821100Medicaid
MD060821100Medicaid
MDD27192Medicare UPIN