Provider Demographics
NPI:1770696460
Name:DELANEY, DALE MICHAEL JR (DPM)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:MICHAEL
Last Name:DELANEY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3504 LAKEVIEW TRAIL
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504
Mailing Address - Country:US
Mailing Address - Phone:252-939-9594
Mailing Address - Fax:252-523-9315
Practice Address - Street 1:402 AIRPORT RD.
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8226
Practice Address - Country:US
Practice Address - Phone:252-523-7070
Practice Address - Fax:252-523-9315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC387213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79-0800EMedicaid
NC79-0800EMedicaid
NCT-95326Medicare UPIN