Individual
MR. JONATHAN ROBERT DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
863 N MAIN STREET EXT STE 200, WALLINGFORD, CT 06492-2434
(203) 265-3280
Mailing address
863 N MAIN STREET EXT STE 200, WALLINGFORD, CT 06492-2434
(203) 265-3280
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4398
CT
Other
Enumeration date
02/28/2010
Last updated
12/21/2019
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