MEDICARE: DR. DALE M GOUGHNOUR DPM

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	213E00000X	Podiatrist	SC004705L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480032181	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GO1304835	OTHER	PW	HIGHMARK
3	304387	OTHER	PA	UPMC
4	043195	OTHER	PA	UMWA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831267806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE M GOUGHNOUR DPM

Provider Business Mailing Address
First Line	:	713 MOUNTAIN AVE STE 1
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-1756
Country	:	US
Telephone Number	:	814-736-5000
Fax Number	:	814-736-9616

Provider Business Practice Location Address
First Line	:	713 MOUNTAIN AVE STE 1
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-1756
Country	:	US
Telephone Number	:	814-736-5000
Fax Number	:	814-736-9616

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/01/2026

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Directions to “ DR. DALE M GOUGHNOUR DPM” Practice Location

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