Provider Demographics
NPI:1821174046
Name:DALTON, JOHN WILFRED SR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILFRED
Last Name:DALTON
Suffix:SR
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 1:1157 HANCOCK STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-786-0141
Mailing Address - Fax:617-479-9827
Practice Address - Street 1:1157 HANCOCK STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-786-0141
Practice Address - Fax:617-479-9827
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41484207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC27096OtherBCBS INDIV PROV
MA6216OtherHARVARD PILGRIM
MA0152757Medicaid
M13881Medicare ID - Type Unspecified
B97330Medicare UPIN