Basic Information
| Provider Information | |||||||||
| NPI: | 1023018462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPONAUGLE | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 NORTHPOINTE PKWY | ||||||||
| Address2: | STE 50 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142281895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166922160 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 OHIO ST | ||||||||
| Address2: | |||||||||
| City: | MEDINA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141031063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857988054 | ||||||||
| FaxNumber: | 5857988150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 08/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 164356 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000525331009 | 01 | NY | BCBS WNY | OTHER | 201590500 | 01 | FEDERAL WORKERS COMP | OTHER | P010164356 | 01 | NY | ROCHESTER BCBS | OTHER | 020382600 | 01 | FEDERAL BLACK LUNG | OTHER | 040403006845 | 01 | NY | FIDELIS CARE NEW YORK | OTHER | 117837FF | 01 | NY | PREFERRED CARE | OTHER | 00020548502 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 01257134 | 05 | NY | MEDICAID | 5690902 | 01 | NY | INDEPENDENT HEALTH | OTHER | 164356 | 01 | NY | WORKERS COMPENSATION | OTHER |