Provider Demographics
NPI:1235146119
Name:DALTON, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:DALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3181
Mailing Address - Country:US
Mailing Address - Phone:304-636-3300
Mailing Address - Fax:
Practice Address - Street 1:812 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-636-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36724207Q00000X
OH35079995207Q00000X
WV20164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1720275571Medicaid
OH2259765Medicaid
GAP0020667OtherRAILROAD MEDICARE
KY0632936Medicare ID - Type Unspecified
OH4057152Medicare ID - Type Unspecified
OH4057155Medicare ID - Type Unspecified
KY0307641Medicare ID - Type Unspecified
KY64038573Medicaid
OH4057153Medicare ID - Type Unspecified
OH2259765Medicaid
OHDA4057151Medicare PIN
GAP0020667OtherRAILROAD MEDICARE
KY3400325Medicare ID - Type Unspecified
OH4057154Medicare ID - Type Unspecified
OH4057156Medicare ID - Type Unspecified
KY0264245Medicare ID - Type Unspecified