Provider Demographics
NPI:1912006040
Name:SPARKS & MACCARTY LTD
Entity Type:Organization
Organization Name:SPARKS & MACCARTY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-572-4074
Mailing Address - Street 1:422 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-5200
Mailing Address - Country:US
Mailing Address - Phone:434-572-4074
Mailing Address - Fax:434-572-4712
Practice Address - Street 1:422 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5200
Practice Address - Country:US
Practice Address - Phone:434-572-4074
Practice Address - Fax:434-572-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0521600001Medicare NSC