Healthcare Provider Details

I. General information

NPI: 1437646874
Provider Name (Legal Business Name): ELISSA CASHMAN DALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 W BALTIMORE PIKE SUITE 3802 RHC 3
MEDIA PA
19063-5139
US

IV. Provider business mailing address

1098 W BALTIMORE PIKE STE 3402
MEDIA PA
19063-5139
US

V. Phone/Fax

Practice location:
  • Phone: 610-520-0700
  • Fax:
Mailing address:
  • Phone: 610-520-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD481202
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD481202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: