Healthcare Provider Details

I. General information

NPI: 1518909738
Provider Name (Legal Business Name): GORDON VINCENT DALTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5899 BREMO RD SUITE 100
RICHMOND VA
23226-1935
US

IV. Provider business mailing address

1115 BOULDERS PKWY SUITE 200
NORTH CHESTERFIELD VA
23225-4067
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8512
  • Fax: 804-288-4552
Mailing address:
  • Phone: 804-560-5595
  • Fax: 804-560-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number101043135
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101043135
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: