Provider Demographics
NPI:1750324943
Name:DALTON, LAURA S (DO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:DALTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:329 NEWTON CT
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1074
Mailing Address - Country:US
Mailing Address - Phone:856-854-2027
Mailing Address - Fax:856-854-7745
Practice Address - Street 1:1636 ROUTE 38
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2900
Practice Address - Country:US
Practice Address - Phone:609-261-7023
Practice Address - Fax:609-914-8471
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04065500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E79640Medicare UPIN
PA073775Medicare ID - Type Unspecified