Healthcare Provider Details

I. General information

NPI: 1760694269
Provider Name (Legal Business Name): DALE L. DEAHN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
ARCADE NY
14009-1113
US

IV. Provider business mailing address

401 MAIN ST
ARCADE NY
14009-1113
US

V. Phone/Fax

Practice location:
  • Phone: 585-492-5088
  • Fax:
Mailing address:
  • Phone: 585-492-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DALE L DEAHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 585-492-5088