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NPI Code Detail

MEDICARE: MR. MICHAEL DIAL PA

MEDICARE: MR. MICHAEL DIAL PA
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
1363A00000XPhysician Assistant103519NC
2363AM0700XMedical Physician Assistant103519NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D2840OTHERNCMEDCOST ID
27436706OTHERNCAETNA ID

General Provider Information

NPI Number : 1346242443
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL DIAL PA
Provider Business Mailing Address
First Line : 2100 STANTONSBURG RD
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-2818
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 250 SMITH CHURCH RD
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-4914
Country : US
Telephone Number : 252-535-8011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2005
Last Update Date : 01/20/2022

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