MEDICARE: DR. PATRICIA DALTON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1274	DC
2	103TC0700X	Clinical Psychologist	0810002025	VA

General Provider Information

NPI Number	:	1487731055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA DALTON PHD

Provider Business Mailing Address
First Line	:	4545 CONNECTICUT AVENUE NW
Second Line	:	SUITE 309
City	:	WASHINGTON
State	:	DC
Zip	:	20008-6042
Country	:	US
Telephone Number	:	202-537-0330
Fax Number	:	703-671-6157

Provider Business Practice Location Address
First Line	:	4545 CONNECTICUT AVENUE NW
Second Line	:	SUITE 309
City	:	WASHINGTON
State	:	DC
Zip	:	20008-6042
Country	:	US
Telephone Number	:	202-537-0330
Fax Number	:	703-671-6157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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