Healthcare Provider Details

I. General information

NPI: 1265462899
Provider Name (Legal Business Name): HENRY TUCKER DALTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 FAIRFAX DR SUITE 74
ARLINGTON VA
22203-1762
US

IV. Provider business mailing address

3801 FAIRFAX DR SUITE 74
ARLINGTON VA
22203-1762
US

V. Phone/Fax

Practice location:
  • Phone: 703-528-3910
  • Fax: 703-528-4367
Mailing address:
  • Phone: 703-528-3910
  • Fax: 703-528-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number21925
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: