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General NPI Number Information
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NPI Number | 1639198138
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Entity Type | Individual
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Provider Name | DALE COLLINS VIDAL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 127 MASCOMA ST
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City | LEBANON
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State | NH
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Zip | 03766-2661
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Country | US
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Telephone | 603-443-9572
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Fax | 603-443-9521
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Provider Business Mailing Address
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Address Line | 10 ALICE PECK DAY DR
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City | LEBANON
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State | NH
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Zip | 03766-2900
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Country | US
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Telephone | 603-448-3121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 9412
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License Number State | NH
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