Provider Demographics
NPI:1265462899
Name:DALTON, HENRY TUCKER (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:TUCKER
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 1:3801 FAIRFAX DR
Mailing Address - Street 2:SUITE 74
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1762
Mailing Address - Country:US
Mailing Address - Phone:703-528-3910
Mailing Address - Fax:703-528-4367
Practice Address - Street 1:3801 FAIRFAX DR
Practice Address - Street 2:SUITE 74
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-528-3910
Practice Address - Fax:703-528-4367
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA21925207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2296785OtherCIGNA
VA6393080Medicaid
VA006279OtherANTHEM BC/BS
VA5585OtherCAREFIRST BC/BS
VA2014566OtherUNITED HEALTHCARE
VA2014566OtherUNITED HEALTHCARE
VA2296785OtherCIGNA