Provider Demographics
NPI:1194725275
Name:DALE, PRISCILLA K (MD)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:K
Last Name:DALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1442
Mailing Address - Country:US
Mailing Address - Phone:716-592-3600
Mailing Address - Fax:716-592-2929
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1442
Practice Address - Country:US
Practice Address - Phone:716-592-3600
Practice Address - Fax:716-592-2929
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0145550001OtherDMERC
NY194016-2OtherWORKERS COMP
NY01443250Medicaid
NY110076542OtherRR MEDICARE
NY00020007301OtherUNIVERA
NY000523043001OtherBCBS
NY0405756AOAOtherINDEPENDENT HEALTH
NY160993858OtherCHAMPUS
NY0003153OtherGHI
NY160993858OtherCHAMPUS
NYA48230Medicare PIN