Provider Demographics
NPI:1780660290
Name:GADDY, DALE METON (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:METON
Last Name:GADDY
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 1:100 HOSPITAL LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1989
Mailing Address - Country:US
Mailing Address - Phone:317-745-3758
Mailing Address - Fax:317-745-3749
Practice Address - Street 1:100 HOSPITAL LN
Practice Address - Street 2:SUITE 220
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1989
Practice Address - Country:US
Practice Address - Phone:317-745-3758
Practice Address - Fax:317-745-3749
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031919A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4073181OtherAETNA
IN000000092882OtherBLUESHIELD
IN100133670Medicaid
IN2016490OtherCIGNA
INC24845Medicare UPIN
IN198710BMedicare PIN
IN000000092882OtherBLUESHIELD