Provider Demographics
NPI:1457354979
Name:SPARROW, RICHARD D (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:SPARROW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 KENT RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4601
Mailing Address - Country:US
Mailing Address - Phone:330-310-6938
Mailing Address - Fax:330-688-4241
Practice Address - Street 1:116 EAST AVE
Practice Address - Street 2:STE 4
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2328
Practice Address - Country:US
Practice Address - Phone:330-310-6938
Practice Address - Fax:330-633-6028
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002144-S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561691Medicaid
OH341443050OtherTAX ID
OH341443050-001OtherMMO
OH470275OtherUNITED HEALTHCARE
OH480003267OtherRAILROAD MEDICARE
OH000000165800OtherANTHEM
OH4280847OtherAETNA
OH4280847OtherAETNA
OH341443050OtherTAX ID