Healthcare Provider Details

I. General information

NPI: 1114022274
Provider Name (Legal Business Name): DALE ERIC PANZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 LAFAYETTE RD
GLADWYNE PA
19035-1111
US

IV. Provider business mailing address

1305 LAFAYETTE RD
GLADWYNE PA
19035-1111
US

V. Phone/Fax

Practice location:
  • Phone: 610-651-0657
  • Fax: 610-722-0704
Mailing address:
  • Phone: 610-651-0657
  • Fax: 610-722-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD050187-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: