Provider Demographics
NPI:1710183231
Name:SPROUSE, ADRIENNE BUFFALOE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:BUFFALOE
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:ROXANNE
Other - Last Name:BUFFALOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31 E 31ST ST
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6829
Mailing Address - Country:US
Mailing Address - Phone:212-725-5744
Mailing Address - Fax:646-649-2461
Practice Address - Street 1:31 E 31ST ST
Practice Address - Street 2:SUITE 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6829
Practice Address - Country:US
Practice Address - Phone:212-725-5744
Practice Address - Fax:646-649-2461
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1840931207Q00000X, 2083T0002X
NY1840932083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32088Medicare UPIN