Provider Demographics
NPI:1417912684
Name:SAPONARO, STEPHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:SAPONARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-636-6798
Mailing Address - Fax:760-773-1802
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-636-6798
Practice Address - Fax:760-773-1802
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062393L2085R0202X
OK260462085R0202X
NJ25MA076142002085R0202X
CAG886032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00971901OtherRXR MCR
PA001659570Medicaid
PA0434981000OtherIBC KHPE
NJP00390756OtherRRMC
PA231955165OtherINTERGROUP SERVICES
PA231955165OtherAETNA USHC
PA001659570OtherAMERICHOICE OF PA
PA0016595700015Medicaid
PAMD062393LOtherHEALTH PARTNERS
PAPA7584OtherHEALTHNET
NJ0035875Medicaid
PA30033205OtherKEYSTONE MERCY
OK200129230AMedicaid
PA966739OtherHIGHMARK BLUE SHIELD
PAP00403740OtherRRMC
PA9445645OtherPHCS
CADA922XMedicare PIN
PA000427Medicare ID - Type Unspecified
OKP00470687Medicare PIN
NJ075039VSBMedicare PIN
CAP00971901OtherRXR MCR
PA231955165OtherINTERGROUP SERVICES
OKOK100339Medicare PIN