Provider Demographics
NPI:1144742917
Name:DALTON, AMY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:DALTON
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Gender:F
Credentials:DO
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Mailing Address - Street 1:325 MEETING HOUSE LANE
Mailing Address - Street 2:BLDG. 2 SUITE 301
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968
Mailing Address - Country:US
Mailing Address - Phone:631-283-4048
Mailing Address - Fax:631-283-5396
Practice Address - Street 1:325 MEETING HOUSE LANE
Practice Address - Street 2:BLDG. 2 SUITE 301
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-283-4048
Practice Address - Fax:631-283-5396
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-01-04
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Provider Licenses
StateLicense IDTaxonomies
NY304210207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400304663OtherMEDICARE PART B