Basic Information
| Provider Information | |||||||||
| NPI: | 1225004005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALTON | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ELLIOT BREAST HEALTH CENTER | ||||||||
| Address2: | 275 MAMMOTH ROAD, SUITE 1 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036683067 | ||||||||
| FaxNumber: | 6036680164 | ||||||||
| Practice Location | |||||||||
| Address1: | ELLIOT BREAST HEALTH CENTER | ||||||||
| Address2: | 275 MAMMOTH ROAD, SUITE 1 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036683067 | ||||||||
| FaxNumber: | 6036680164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 5738 | NH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 802241 | 01 | NH | HPHC PIN | OTHER | 2090 | 01 | NH | CIGNA PIN | OTHER | B86105 | 01 | NH | ANTHEM REFERRING UPIN | OTHER | 0104175Y0NH01 | 01 | NH | ANTHEM ACES # | OTHER | 2794202 | 01 | NH | AETNA PIN | OTHER | 40204175 | 05 | NH | MEDICAID | 723004 | 01 | NH | TUFTS PIN | OTHER |