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NPI Code Detail

MEDICARE: DALE T. RALSTON P.A.

MEDICARE: DALE T. RALSTON P.A.
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
1363AM0700XMedical Physician AssistantOA000732PA
2363AM0700XMedical Physician AssistantMA000158LPA

General Provider Information

NPI Number : 1326201732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALE T. RALSTON P.A.
Provider Business Mailing Address
First Line : PO BOX 199
Second Line :
City : RIDLEY PARK
State : PA
Zip : 19078-0199
Country : US
Telephone Number : 610-521-6063
Fax Number : 610-521-0163
Provider Business Practice Location Address
First Line : 1510 CHESTER PIKE
Second Line : SUITE 130
City : EDDYSTONE
State : PA
Zip : 19022-1375
Country : US
Telephone Number : 610-521-6063
Fax Number : 610-521-0163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2008
Last Update Date : 03/08/2017

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Directions to “ DALE T. RALSTON P.A.” Practice Location

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