Basic Information
| Provider Information | |||||||||
| NPI: | 1508800384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHLE | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 S MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171122647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176520799 | ||||||||
| FaxNumber: | 7177950407 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 CENTURY DR | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170554374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177950330 | ||||||||
| FaxNumber: | 7177950407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | OS005003L | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0009104900008 | 05 | PA | MEDICAID |