Provider Demographics
NPI:1730361932
Name:HALTON, THOMAS LAWRENCE (DOCTOR OF SCIENCE)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:HALTON
Suffix:
Gender:M
Credentials:DOCTOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 QUEENSBERRY ST
Mailing Address - Street 2:APT 19
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5246
Mailing Address - Country:US
Mailing Address - Phone:617-536-8896
Mailing Address - Fax:
Practice Address - Street 1:36 QUEENSBERRY ST
Practice Address - Street 2:APT 19
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5246
Practice Address - Country:US
Practice Address - Phone:617-536-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2548133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist