MEDICARE: DALE KANTRICE RADER 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	207X00000X	Orthopaedic Surgery Physician	200700675	NC
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	200700675	NC

General Provider Information

NPI Number	:	1043202542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE KANTRICE RADER MD

Provider Business Mailing Address
First Line	:	1414 FERN CREEK DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-9376
Country	:	US
Telephone Number	:	704-873-6065
Fax Number	:	704-873-6058

Provider Business Practice Location Address
First Line	:	1414 FERN CREEK DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-9376
Country	:	US
Telephone Number	:	704-873-6065
Fax Number	:	704-873-6058

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	02/28/2023

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