Provider Demographics
NPI:1407812316
Name:SPARKS, ALISANDE B (MD)
Entity type:Individual
Prefix:
First Name:ALISANDE
Middle Name:B
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3747
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:30 W COLE RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9458
Practice Address - Country:US
Practice Address - Phone:207-282-9080
Practice Address - Fax:207-282-9180
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027405OtherANTHEM
ME2070058OtherAETNA
MEF20883OtherHARVARD
MEM10002501OtherCIGNA
MEMM4151Medicare ID - Type Unspecified
MEM10002501OtherCIGNA