Provider Demographics
NPI:1366498677
Name:DALES, LINDA MARY (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARY
Last Name:DALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4026
Mailing Address - Country:US
Mailing Address - Phone:601-703-3820
Mailing Address - Fax:601-703-0125
Practice Address - Street 1:1516 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4026
Practice Address - Country:US
Practice Address - Phone:601-703-3820
Practice Address - Fax:601-703-0125
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000203207RE0101X
SC30413207RE0101X
MS21644207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC304138Medicaid
NCP00326699OtherRAILROAD MEDICARE
MS00358088Medicaid
NC12700OtherBCBSNC
NC8912700Medicaid
SCGP4505Medicaid
NC188453OtherMEDCOST
NC2119923OtherCIGNA HEALTHCARE
SCAA25911162Medicare PIN
SCAA25910281Medicare PIN
SCGP4505Medicaid
NCP00326699OtherRAILROAD MEDICARE
MS302I466775Medicare PIN
NC2280799AMedicare ID - Type Unspecified