Healthcare Provider Details

I. General information

NPI: 1922034479
Provider Name (Legal Business Name): DALE JEANNE LACROIX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 INTERSTATE PKWY
BRADFORD PA
16701-1013
US

IV. Provider business mailing address

10601 E GOLD PANNING CT
COLD CANYON AZ
85518-5110
US

V. Phone/Fax

Practice location:
  • Phone: 814-362-8480
  • Fax:
Mailing address:
  • Phone: 802-233-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0420010133
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number62063
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD19859
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number35.144459
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD473007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: