Organization
CONCORD MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRISCILLA K DALE MD (PRESIDENT)
(716) 592-3000
Entity
Organization
Contact information
Practice address
210 E MAIN ST, SPRINGVILLE, NY 14141-1442
(716) 592-3600
Mailing address
210 E MAIN ST, SPRINGVILLE, NY 14141-1442
(716) 592-3600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003153
GHI
NY
05
—
00619338
—
NY
01
—
30500G
EMPIRE
NY
01
—
C31179
RR MEDICARE
NY
Enumeration date
07/17/2006
Last updated
07/21/2022
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