MEDICARE: DALTON MEDICAL ASSOCIATES, LLP

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	207R00000X	Internal Medicine Physician	49734	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831225689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALTON MEDICAL ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	33 NORTH ST
Second Line	:
City	:	DALTON
State	:	MA
Zip	:	01226-1202
Country	:	US
Telephone Number	:	413-684-2110
Fax Number	:	413-684-1517

Provider Business Practice Location Address
First Line	:	33 NORTH ST
Second Line	:
City	:	DALTON
State	:	MA
Zip	:	01226-1202
Country	:	US
Telephone Number	:	413-684-2110
Fax Number	:	413-684-1517

Authorized Official
Title or Position	:	C0-PARTNER
Name	:	DR. THOMAS J VAUGHAN
Credential	:	MD
Telephone Number	:	413-684-2110

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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