Basic Information
| Provider Information | |||||||||
| NPI: | 1992752638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARHAWK | ||||||||
| FirstName: | DANA P B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2191 POST RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017388100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2191 POST RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017388100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 57653 | MA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.