Healthcare Provider Details

I. General information

NPI: 1962152660
Provider Name (Legal Business Name): SPENSER WALTER VINES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVENUE DEPT. OF EMERGENCY MEDICINE
ALBANY NY
12208
US

IV. Provider business mailing address

43 NEW SCOTLAND AVENUE DEPT. OF EMERGENCY MEDICINE
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-6455
  • Fax:
Mailing address:
  • Phone: 518-262-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number326136
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number326136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: