Provider Demographics
NPI:1629085865
Name:SLAGEL, DALE EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EVERETT
Last Name:SLAGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-747-5770
Mailing Address - Fax:804-747-5746
Practice Address - Street 1:7700 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4301
Practice Address - Country:US
Practice Address - Phone:804-747-5770
Practice Address - Fax:804-747-5746
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026588207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA172002OtherANTHEM BS
VA6034632Medicaid
930088825OtherRR MEDICARE
B05440Medicare UPIN
930088825OtherRR MEDICARE