Basic Information
| Provider Information | |||||||||
| NPI: | 1629031323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENARD | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1985 TATE BLVD SE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286021498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284852510 | ||||||||
| FaxNumber: | 8284852517 | ||||||||
| Practice Location | |||||||||
| Address1: | 1985 TATE BLVD SE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286021498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284852510 | ||||||||
| FaxNumber: | 8284852517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 9401453 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 89015NT | 05 | NC | MEDICAID | BM15974434 | 01 | NC | DEA | OTHER | 8958601 | 05 | NC | MEDICAID |