Provider Demographics
NPI:1639158561
Name:SPARHAWK, G ROGER JR (MD)
Entity Type:Individual
Prefix:
First Name:G
Middle Name:ROGER
Last Name:SPARHAWK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:SPARHAWK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-665-8225
Mailing Address - Fax:330-665-8229
Practice Address - Street 1:4125 MEDINA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-665-8225
Practice Address - Fax:330-665-8229
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0409862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2738103Medicaid
OH0754597OtherMEDICARE ID
OH341790929185OtherCARESOURCE ID
OH341790929185OtherCARESOURCE ID