Provider Demographics
NPI:1922087741
Name:THOMAE, DALE R (DO)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:THOMAE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2212 MIFFLIN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8848
Mailing Address - Country:US
Mailing Address - Phone:419-289-6317
Mailing Address - Fax:419-207-2658
Practice Address - Street 1:2212 MIFFLIN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8848
Practice Address - Country:US
Practice Address - Phone:419-289-6317
Practice Address - Fax:419-207-2658
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34005824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0987544Medicaid
OHF90516Medicare UPIN
OH0786017Medicare PIN