Provider Demographics
NPI:1629031323
Name:MENARD, DALE ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ANTHONY
Last Name:MENARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1985 TATE BLVD SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1498
Mailing Address - Country:US
Mailing Address - Phone:828-485-2510
Mailing Address - Fax:828-485-2517
Practice Address - Street 1:1985 TATE BLVD SE
Practice Address - Street 2:SUITE 600
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1498
Practice Address - Country:US
Practice Address - Phone:828-485-2510
Practice Address - Fax:828-485-2517
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94014532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015NTMedicaid
NC8958601Medicaid
NC8958601Medicaid
NC8958601Medicaid
NC2206619CMedicare ID - Type Unspecified
NCBM15974434OtherDEA