Provider Demographics
NPI:1497761092
Name:WALTON, BENITA J (MD)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:J
Last Name:WALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LYME RD STE 204A
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1221
Mailing Address - Country:US
Mailing Address - Phone:603-277-9894
Mailing Address - Fax:603-277-9896
Practice Address - Street 1:45 LYME RD STE 204A
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1221
Practice Address - Country:US
Practice Address - Phone:603-277-9894
Practice Address - Fax:603-277-9896
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH78582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3104608Medicaid