Provider Demographics
NPI:1225013493
Name:DALTON, JOHN SHAW II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SHAW
Last Name:DALTON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2W ROLLING CROSSROADS
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6209
Mailing Address - Country:US
Mailing Address - Phone:410-788-8033
Mailing Address - Fax:410-788-8034
Practice Address - Street 1:2W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 205
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6209
Practice Address - Country:US
Practice Address - Phone:410-788-8033
Practice Address - Fax:410-788-8034
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-10
Last Update Date:2012-06-27
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Provider Licenses
StateLicense IDTaxonomies
MDD0030542207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336311200Medicaid
MD336311200Medicaid
MDD72031Medicare UPIN