Provider Demographics
NPI:1942322524
Name:DALTON, CLAUDETTE ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:ELLIS
Last Name:DALTON
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 1:3474 BLEAK HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-2213
Mailing Address - Country:US
Mailing Address - Phone:434-974-1844
Mailing Address - Fax:434-974-1783
Practice Address - Street 1:235 CANTRELL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3248
Practice Address - Country:US
Practice Address - Phone:540-437-7971
Practice Address - Fax:540-433-4534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043234207L00000X
NC26435207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0058616000Medicaid
VANOT KNOWNMedicaid
WV0058616000Medicaid