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1023018462

NPI Code Detail

MEDICARE: DALE W SPONAUGLE MD

MEDICARE: DALE W SPONAUGLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	164356	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000525331009	OTHER	NY	BCBS WNY
2	201590500	OTHER		FEDERAL WORKERS COMP
3	P010164356	OTHER	NY	ROCHESTER BCBS
4	020382600	OTHER		FEDERAL BLACK LUNG
5	040403006845	OTHER	NY	FIDELIS CARE NEW YORK
6	117837FF	OTHER	NY	PREFERRED CARE
7	00020548502	OTHER	NY	UNIVERA HEALTHCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	5690902	OTHER	NY	INDEPENDENT HEALTH
10	164356	OTHER	NY	WORKERS COMPENSATION

General Provider Information

NPI Number	:	1023018462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE W SPONAUGLE MD

Provider Business Mailing Address
First Line	:	275 NORTHPOINTE PKWY
Second Line	:	STE 50
City	:	AMHERST
State	:	NY
Zip	:	14228-1895
Country	:	US
Telephone Number	:	716-692-2160
Fax Number	:	716-692-4342

Provider Business Practice Location Address
First Line	:	200 OHIO ST
Second Line	:
City	:	MEDINA
State	:	NY
Zip	:	14103-1063
Country	:	US
Telephone Number	:	585-798-8054
Fax Number	:	585-798-8150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/30/2017

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Directions to “ DALE W SPONAUGLE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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