Provider Demographics
NPI:1508848987
Name:COOMBS, DALE TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:TIMOTHY
Last Name:COOMBS
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 1:145 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-3371
Mailing Address - Country:US
Mailing Address - Phone:814-723-8023
Mailing Address - Fax:814-723-8025
Practice Address - Street 1:145 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-3371
Practice Address - Country:US
Practice Address - Phone:814-723-8023
Practice Address - Fax:814-723-8025
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052426L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics