Provider Demographics
NPI:1043210941
Name:DALTNER, LYNN A (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:A
Last Name:DALTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 ALMA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-4012
Mailing Address - Country:US
Mailing Address - Phone:703-642-5990
Mailing Address - Fax:703-642-5003
Practice Address - Street 1:5510 ALMA LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-4012
Practice Address - Country:US
Practice Address - Phone:703-642-5990
Practice Address - Fax:703-642-5003
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1079335OtherAFFORDABLE FIRST HEALTH
VA5865565Medicaid
VA0403418OtherUNITED HEALTH MID-ATLANTI
VA0403418OtherUNITED HEALTH VIRGINIA
VA453710OtherTRIGON KEYAD
VA0544728OtherAETNA/US HEALTHCARE
VA504071OtherNCPPO
VA295698OtherMDIPA/OPTIMUM CHOICE/MAMS
VA382881OtherONE HEALTH GREATWEST
VA5052074OtherAHP MGD CHOICE
VA453710OtherANTHEM HEALTHKEEPERS
VA45560014OtherBCBS DC/CAPCARE
VA7978415005OtherCIGNA HMO
VA007940V39Medicare ID - Type UnspecifiedMEDICARE
VA5865565Medicaid