Provider Demographics
NPI:1245498062
Name:DALTON, JOSHUA HEATH (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:HEATH
Last Name:DALTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 EAST 27ST N
Mailing Address - Street 2:STE 2
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219
Mailing Address - Country:US
Mailing Address - Phone:276-523-5080
Mailing Address - Fax:276-523-5083
Practice Address - Street 1:14 EAST 27ST N
Practice Address - Street 2:STE 2
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219
Practice Address - Country:US
Practice Address - Phone:276-523-5080
Practice Address - Fax:276-523-5083
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202333207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC12093Medicare PIN