Provider Demographics
NPI:1306808159
Name:SPRENKLE, BOYD EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:BOYD
Middle Name:EDWIN
Last Name:SPRENKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK ROAD
Mailing Address - Street 2:SUITE #280
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6494
Mailing Address - Country:US
Mailing Address - Phone:240-964-8750
Mailing Address - Fax:240-964-8699
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:SUITE #280
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:240-964-8750
Practice Address - Fax:240-964-8699
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054946207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774141301Medicaid
DCK307-0014OtherGHMSI
MD567B 768841-03OtherCAREFIRST
G29068Medicare UPIN
MDK936Medicare PIN