1366646648 NPI number — DR. KATHRYN HAVERINGTON DALTON D.O.

Table of content: DR. KATHRYN HAVERINGTON DALTON D.O. (NPI 1366646648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366646648 NPI number — DR. KATHRYN HAVERINGTON DALTON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALTON
Provider First Name:
KATHRYN
Provider Middle Name:
HAVERINGTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALTON RICKER
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
HAVERINGTON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366646648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CAMP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-3063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-775-1984
Provider Business Mailing Address Fax Number:
508-790-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CAMP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-3063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-775-1984
Provider Business Practice Location Address Fax Number:
508-790-1897
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  5101017214 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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