Organization
DALE WARREN SPONAUGLE, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE W SPONAUGLE MD (OWNER)
(585) 798-8054
Entity
Organization
Contact information
Practice address
200 OHIO ST, MEDINA, NY 14103-1063
(585) 798-8054
Mailing address
908 NIAGARA FALLS BLVD, STE 208, N TONAWANDA, NY 14120-2019
(716) 692-3302
(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
NY
01
—
000525331009
BLUE CROSS OF WNY
NY
05
—
01257134
—
NY
01
—
040426004344
FIDELIS
NY
01
—
5690902
IHA
NY
01
—
9600955
GHI - PPO
NY
01
—
P010164356
BLUE CHOICE
NY
Enumeration date
11/18/2008
Last updated
11/18/2008
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