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NPI Code Detail

MEDICARE: LEONARD E. DALE II MD

MEDICARE: LEONARD E. DALE II 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
12085R0202XDiagnostic Radiology PhysicianMD013080EPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811993744
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARD E. DALE II MD
Provider Business Mailing Address
First Line : PO BOX 21
Second Line :
City : WELLSBORO
State : PA
Zip : 16901-0021
Country : US
Telephone Number : 570-723-0163
Fax Number : 570-723-0188
Provider Business Practice Location Address
First Line : 32-36 CENTRAL AVE
Second Line :
City : WELLSBORO
State : PA
Zip : 16901-1840
Country : US
Telephone Number : 570-723-0163
Fax Number : 570-723-0188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 11/10/2009

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