Provider Demographics
NPI:1326024373
Name:MIKA, KATHERINE DALTON (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DALTON
Last Name:MIKA
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 1:3067 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:KESWICK
Mailing Address - State:VA
Mailing Address - Zip Code:22947-2720
Mailing Address - Country:US
Mailing Address - Phone:434-984-8899
Mailing Address - Fax:
Practice Address - Street 1:1522 INSURANCE LN
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7229
Practice Address - Country:US
Practice Address - Phone:434-974-9600
Practice Address - Fax:434-296-1036
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006725783Medicaid
VA010718OtherCIGNA
VA333852OtherANTHEM
VA20028OtherVETRI
VA267171OtherMAMSI/ALLIANCE
VA12062400003OtherSOUTHERN HEALTH