Healthcare Provider Details

I. General information

NPI: 1043650443
Provider Name (Legal Business Name): SEAN SPENCER LONDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18436 ROSCOE BLVD
NORTHRIDGE CA
91325-4107
US

IV. Provider business mailing address

1460 PASTEL LN STE 400
NOVATO CA
94947-4524
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-1400
  • Fax:
Mailing address:
  • Phone: 415-847-5850
  • Fax: 303-318-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number63106
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number161034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: