Provider Demographics
NPI:1922665660
Name:WHALEY, DALTON THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:THOMAS
Last Name:WHALEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 BISSELL RD
Mailing Address - Street 2:
Mailing Address - City:FLY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13337-2109
Mailing Address - Country:US
Mailing Address - Phone:518-955-0752
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1394
Practice Address - Country:US
Practice Address - Phone:607-547-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant