Healthcare Provider Details

I. General information

NPI: 1326201732
Provider Name (Legal Business Name): DALE T. RALSTON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CHESTER PIKE SUITE 130
EDDYSTONE PA
19022-1375
US

IV. Provider business mailing address

PO BOX 199
RIDLEY PARK PA
19078-0199
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-6063
  • Fax: 610-521-0163
Mailing address:
  • Phone: 610-521-6063
  • Fax: 610-521-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA000732
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000158L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: