Healthcare Provider Details

I. General information

NPI: 1235137852
Provider Name (Legal Business Name): BRIAN EDWARD DALTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST STE 401
ERIE PA
16507
US

IV. Provider business mailing address

333 STATE ST STE 103
ERIE PA
16507-1450
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-1013
  • Fax: 814-459-0435
Mailing address:
  • Phone: 814-877-7157
  • Fax: 814-877-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD032277E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: