Provider Demographics
NPI:1649220252
Name:SPRAGUE, CURTIS DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:DAVIS
Last Name:SPRAGUE
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 1:279 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1623
Mailing Address - Country:US
Mailing Address - Phone:845-255-3046
Mailing Address - Fax:845-255-0236
Practice Address - Street 1:279 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1623
Practice Address - Country:US
Practice Address - Phone:845-255-2930
Practice Address - Fax:845-255-3089
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY29E3720581OtherMEDICARE PTAN
NY01087847Medicaid
NY29E3720581Medicare PIN
NYC07891Medicare UPIN