Provider Demographics
NPI:1225004005
Name:DALTON, EDWARD P (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:DALTON
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:ELLIOT BREAST HEALTH CENTER
Mailing Address - Street 2:275 MAMMOTH ROAD, SUITE 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109
Mailing Address - Country:US
Mailing Address - Phone:603-668-3067
Mailing Address - Fax:603-668-0164
Practice Address - Street 1:ELLIOT BREAST HEALTH CENTER
Practice Address - Street 2:275 MAMMOTH ROAD, SUITE 1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109
Practice Address - Country:US
Practice Address - Phone:603-668-3067
Practice Address - Fax:603-668-0164
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5738208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH802241OtherHPHC PIN
NH2090OtherCIGNA PIN
NHB86105OtherANTHEM REFERRING UPIN
NH0104175Y0NH01OtherANTHEM ACES #
NH2794202OtherAETNA PIN
NH40204175Medicaid
NH723004OtherTUFTS PIN
NHNH4175Medicare PIN
NH802241OtherHPHC PIN