Provider Demographics
NPI:1104855485
Name:PCSOLYAR, DALE WILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:WILTON
Last Name:PCSOLYAR
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:220 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3107
Mailing Address - Country:US
Mailing Address - Phone:540-899-2900
Mailing Address - Fax:540-899-3395
Practice Address - Street 1:220 EXECUTIVE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3107
Practice Address - Country:US
Practice Address - Phone:540-899-2900
Practice Address - Fax:540-899-3395
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010408442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE34421Medicare UPIN