Provider Demographics
NPI:1023018462
Name:SPONAUGLE, DALE W (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:W
Last Name:SPONAUGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:275 NORTHPOINTE PKWY
Mailing Address - Street 2:STE 50
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1895
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:200 OHIO ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1063
Practice Address - Country:US
Practice Address - Phone:585-798-8054
Practice Address - Fax:585-798-8150
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2017-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1643562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525331009OtherBCBS WNY
201590500OtherFEDERAL WORKERS COMP
NYP010164356OtherROCHESTER BCBS
020382600OtherFEDERAL BLACK LUNG
NY040403006845OtherFIDELIS CARE NEW YORK
NY117837FFOtherPREFERRED CARE
NY00020548502OtherUNIVERA HEALTHCARE
NY01257134Medicaid
NY5690902OtherINDEPENDENT HEALTH
NY164356OtherWORKERS COMPENSATION
NY01257134Medicaid
NY040403006845OtherFIDELIS CARE NEW YORK