MEDICARE: STEPHANIE SPANO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	35184	NH
2	2085R0202X	Diagnostic Radiology Physician	MD29528	ME
3	2085R0204X	Vascular & Interventional Radiology Physician	313960	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538515523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SPANO MD

Provider Business Mailing Address
First Line	:	1775 YORK AVE APT 5H
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6906
Country	:	US
Telephone Number	:	917-817-0924
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 E FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5406
Country	:	US
Telephone Number	:	855-615-2555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	01/15/2026

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