Provider Demographics
NPI:1841232956
Name:SPRAGUE, EDWARD D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:SPRAGUE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HIGHLAND STREET
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469
Mailing Address - Country:US
Mailing Address - Phone:978-597-8166
Mailing Address - Fax:978-597-0061
Practice Address - Street 1:120 HIGHLAND STREET
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1128
Practice Address - Country:US
Practice Address - Phone:978-597-8166
Practice Address - Fax:978-597-0061
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0114308Medicaid
MAB44008Medicare ID - Type Unspecified
MAB73157Medicare UPIN