Provider Demographics
NPI:1104029206
Name:DALTON, ASHLEY P (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:P
Last Name:DALTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W CENTRAL RD
Mailing Address - Street 2:# 3800
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-255-0900
Mailing Address - Fax:
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:# 3800
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-255-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363062013OtherEIN
ILK38857Medicare PIN
ILK38856Medicare PIN