Provider Demographics
NPI:1790866846
Name:HUME, DALE ALLYN (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ALLYN
Last Name:HUME
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:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-5610
Mailing Address - Country:US
Mailing Address - Phone:740-774-1111
Mailing Address - Fax:740-774-4074
Practice Address - Street 1:47 N PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1760
Practice Address - Country:US
Practice Address - Phone:740-774-1111
Practice Address - Fax:740-774-4074
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0634482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000006921OtherANTHEM BC/BS
OH0879161Medicaid
000000006921OtherANTHEM BC/BS-FEDERAL
310851206015OtherMEDICAL MUTUAL OF OHIO
300045100OtherRAILROAD MEDICARE
F28969Medicare UPIN
OH0879161Medicaid