Individual
DALE W SPONAUGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 OHIO ST, MEDINA, NY 14103-1063
(585) 798-8054
(585) 798-8150
Mailing address
275 NORTHPOINTE PKWY, STE 50, AMHERST, NY 14228-1895
(716) 692-2160
(716) 692-4342
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
164356
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020548502
UNIVERA HEALTHCARE
NY
01
—
000525331009
BCBS WNY
NY
05
—
01257134
—
NY
01
—
020382600
FEDERAL BLACK LUNG
—
01
—
040403006845
FIDELIS CARE NEW YORK
NY
01
—
117837FF
PREFERRED CARE
NY
01
—
164356
WORKERS COMPENSATION
NY
01
—
201590500
FEDERAL WORKERS COMP
—
01
—
5690902
INDEPENDENT HEALTH
NY
01
—
P010164356
ROCHESTER BCBS
NY
Enumeration date
07/28/2005
Last updated
08/30/2017
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