Provider Demographics
NPI:1174506646
Name:YU, DALE PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:PATRICK
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5184 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2738
Mailing Address - Country:US
Mailing Address - Phone:513-868-1786
Mailing Address - Fax:513-868-1758
Practice Address - Street 1:5184 SANDY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2738
Practice Address - Country:US
Practice Address - Phone:513-868-1786
Practice Address - Fax:513-868-1758
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408773Medicaid
H88602Medicare UPIN
4111611Medicare ID - Type Unspecified