Provider Demographics
NPI:1801019229
Name:R.& D. DALE, M.D., INC.
Entity Type:Organization
Organization Name:R.& D. DALE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-356-4227
Mailing Address - Street 1:PO BOX 451286
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0633
Mailing Address - Country:US
Mailing Address - Phone:440-356-4227
Mailing Address - Fax:440-356-4231
Practice Address - Street 1:20220 CENTER RIDGE RD
Practice Address - Street 2:SUITE 336
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3501
Practice Address - Country:US
Practice Address - Phone:440-356-4227
Practice Address - Fax:440-356-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH378568438005OtherMEDICAL MUTUAL
OH2261494Medicaid
OH=========OtherANTHEM
OH=========OtherANTHEM