Provider Demographics
NPI:1710073366
Name:SPRATT, DANIEL I (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:I
Last Name:SPRATT
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 1:39 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6143
Mailing Address - Country:US
Mailing Address - Phone:207-761-0650
Mailing Address - Fax:207-761-8198
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3166
Practice Address - Country:US
Practice Address - Phone:207-771-5549
Practice Address - Fax:207-771-7834
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12045207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME337810099Medicaid
NH30200578Medicaid
NH30200578Medicaid
MEMM081601Medicare PIN
MEMM0816Medicare PIN
ME337810099Medicaid