Provider Demographics
NPI:1679564777
Name:PAYNE, SPENCER CRANSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:CRANSTON
Last Name:PAYNE
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 RAY C. HUNT DRIVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-0001
Practice Address - Country:US
Practice Address - Phone:434-924-5700
Practice Address - Fax:434-924-1736
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241639207Y00000X
MA227090207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI54803Medicare UPIN
MAA39926Medicare UPIN