Provider Demographics
NPI:1124200514
Name:JAMES G. DALE, D.O.
Entity Type:Organization
Organization Name:JAMES G. DALE, D.O.
Other - Org Name:VALLEY INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-743-6558
Mailing Address - Street 1:250 MEMORIAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1000
Mailing Address - Country:US
Mailing Address - Phone:540-743-6558
Mailing Address - Fax:540-743-3601
Practice Address - Street 1:250 MEMORIAL DR STE D
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1000
Practice Address - Country:US
Practice Address - Phone:540-743-6558
Practice Address - Fax:540-743-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102035799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006046193Medicaid
VA006046193Medicaid