Provider Demographics
NPI:1699866673
Name:DPMSPARROWNROH LLC
Entity type:Organization
Organization Name:DPMSPARROWNROH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-310-6931
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:
Practice Address - Street 1:3517 KENT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4601
Practice Address - Country:US
Practice Address - Phone:330-310-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36. 002744213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80786Medicare UPIN