Provider Demographics
NPI:1306198239
Name:DALE, ROBERT E III (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DALE
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL STE 200
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6095
Mailing Address - Country:US
Mailing Address - Phone:330-729-8146
Mailing Address - Fax:330-965-5229
Practice Address - Street 1:1335 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1135
Practice Address - Country:US
Practice Address - Phone:234-233-2849
Practice Address - Fax:330-747-2211
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055732363A00000X
OH50.003949RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109347Medicaid