Provider Demographics
NPI:1831225689
Name:DALTON MEDICAL ASSOCIATES, LLP
Entity type:Organization
Organization Name:DALTON MEDICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C0-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-684-2110
Mailing Address - Street 1:33 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1202
Mailing Address - Country:US
Mailing Address - Phone:413-684-2110
Mailing Address - Fax:413-684-1517
Practice Address - Street 1:33 NORTH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1202
Practice Address - Country:US
Practice Address - Phone:413-684-2110
Practice Address - Fax:413-684-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9702270Medicaid
MAM20885Medicare ID - Type UnspecifiedDR VAUGHAN
MA9702270Medicaid
MAB74339Medicare UPIN