Provider Demographics
NPI:1609936574
Name:DIAL, WALTER EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EVERETT
Last Name:DIAL
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 1:50B STATE ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:RANGER
Mailing Address - State:WV
Mailing Address - Zip Code:25557-9712
Mailing Address - Country:US
Mailing Address - Phone:304-369-1549
Mailing Address - Fax:
Practice Address - Street 1:701 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1669
Practice Address - Country:US
Practice Address - Phone:304-307-6070
Practice Address - Fax:304-307-6071
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG87756Medicare UPIN