Provider Demographics
NPI:1366646648
Name:DALTON, KATHRYN HAVERINGTON (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:HAVERINGTON
Last Name:DALTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:HAVERINGTON
Other - Last Name:DALTON RICKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:100 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3063
Mailing Address - Country:US
Mailing Address - Phone:508-775-1984
Mailing Address - Fax:508-790-1897
Practice Address - Street 1:100 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3063
Practice Address - Country:US
Practice Address - Phone:508-775-1984
Practice Address - Fax:508-790-1897
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery