1396974044 NPI number — JUSTIN MILES SPRATT D.O.

Table of content: JUSTIN MILES SPRATT D.O. (NPI 1396974044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396974044 NPI number — JUSTIN MILES SPRATT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRATT
Provider First Name:
JUSTIN
Provider Middle Name:
MILES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396974044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 NESHAMINY VALLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENSALEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19020-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-560-5483
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 RED LION ROAD
Provider Second Line Business Practice Location Address:
ARIA HEALTH TORRESDALE OFFICE OF MEDICAL EDUCATION
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-240-6003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  OT012880 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 2847 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OT012880 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)