Provider Demographics
NPI:1962493254
Name:SCHMIDT-DALTON, TARIN (MD)
Entity Type:Individual
Prefix:
First Name:TARIN
Middle Name:
Last Name:SCHMIDT-DALTON
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 1:346 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-1578
Mailing Address - Country:US
Mailing Address - Phone:540-977-2187
Mailing Address - Fax:
Practice Address - Street 1:2145 MOUNT PLEASANT BLVD SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-3632
Practice Address - Country:US
Practice Address - Phone:540-427-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-055361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5636191Medicaid
VA5636183Medicaid
000252C93Medicare PIN
VAG88033Medicare UPIN