Provider Demographics
NPI:1871558817
Name:DALESSIO, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DALESSIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3927
Mailing Address - Country:US
Mailing Address - Phone:513-475-7400
Mailing Address - Fax:513-475-7410
Practice Address - Street 1:40 DUKE MEDICINE CIR
Practice Address - Street 2:STE 4300
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-5778
Practice Address - Fax:919-681-8477
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-077498207R00000X, 207RE0101X
NC2014-00858207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271720Medicaid
KY64011497Medicaid
OH2193826Medicaid
OH2193826Medicaid
IN200271720Medicaid