Provider Demographics
NPI:1518909738
Name:DALTON, GORDON VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:VINCENT
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 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:5899 BREMO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1935
Practice Address - Country:US
Practice Address - Phone:804-288-8512
Practice Address - Fax:804-288-4552
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101043135207XS0114X
VA0101043135207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518909738Medicaid
VA200015994OtherRAILROAD MEDICARE
VA090405OtherANTHEM HEALTHKEEPERS
VA285569OtherSOUTHERN HEALTH
VA540885859OtherC&O EMPLOYEE'S HEALTHCARE
VA006400817Medicaid
VA0735377OtherAETNA HMO
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherCIGNA
VA006400833Medicaid
VA540885859OtherFOCUS
VA0900158OtherUNITED HEALTHCARE
VA2138262OtherUNITED HEALTHCARE MAMSI
VA30767OtherSH CARENET
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA386527OtherANTHEM WEST END OPERATORY
VA46415OtherOPTIMA HEALTH
VA090405OtherANTHEM HEALTHKEEPERS
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA285569OtherSOUTHERN HEALTH
VA200000628Medicare PIN