Healthcare Provider Details

I. General information

NPI: 1225004005
Provider Name (Legal Business Name): EDWARD P. DALTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELLIOT BREAST HEALTH CENTER 275 MAMMOTH ROAD, SUITE 1
MANCHESTER NH
03109
US

IV. Provider business mailing address

ELLIOT BREAST HEALTH CENTER 275 MAMMOTH ROAD, SUITE 1
MANCHESTER NH
03109
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3067
  • Fax: 603-668-0164
Mailing address:
  • Phone: 603-668-3067
  • Fax: 603-668-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5738
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: