Provider Demographics
NPI:1720294127
Name:DIAL, TASHA BARNETT (MD)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:BARNETT
Last Name:DIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:DENEE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:4515 PREMIER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8357
Practice Address - Country:US
Practice Address - Phone:336-802-2200
Practice Address - Fax:336-802-2201
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT184699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908185Medicaid