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Individual

DR. ROBERT ANDREW DALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
600 DAVISSON RUN RD, SUITE 200, CLARKSBURG, WV 26301-9307
(304) 623-6728
(304) 623-2638
Mailing address
600 DAVISSON RUN RD, SUITE 200, CLARKSBURG, WV 26301-9307
(304) 623-6728
(304) 623-2638

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
10395
WV
213E00000X
Podiatrist
N006127
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10395
WV STATE PODIATRY LICENSE
WV
01
311573127
GROUP TAX ID #
WV
05
3810008964
WV
01
N006127
NEW YORK PODIATRY LICENSE
NY
01
P00400794
UMWA (FUNDS)
WV
01
WV10395
HEALTH PLAN
WV
Enumeration date
09/30/2006
Last updated
04/22/2008
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