Provider Demographics
NPI:1306413463
Name:TOMPKINS, DALE ROBERT
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ROBERT
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 GARDNER RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-8035
Mailing Address - Country:US
Mailing Address - Phone:607-776-0567
Mailing Address - Fax:
Practice Address - Street 1:45 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9182
Practice Address - Country:US
Practice Address - Phone:585-335-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161039939OtherALL OTHER INSURANCES
NY161039939Medicaid