Healthcare Provider Details

I. General information

NPI: 1235133133
Provider Name (Legal Business Name): ROSANNE R. DALTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 GARRISON DR
MURFREESBORO TN
37129-2598
US

IV. Provider business mailing address

1272 GARRISON DR
MURFREESBORO TN
37129-2598
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-4480
  • Fax: 615-867-7946
Mailing address:
  • Phone: 615-893-4480
  • Fax: 615-867-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33468
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD42627
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier64343684
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: