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General NPI Number Information
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NPI Number | 1649239641
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Entity Type | Organization
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Legal Business Name | MDCO PA
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1995 BETHABARA RD
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3375
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Country | US
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Telephone | 336-245-0333
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Fax | 336-245-0332
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Provider Business Mailing Address
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Address Line | 1995 BETHABARA RD
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3375
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Country | US
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Telephone | 336-759-7596
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TIMOTHY JOHN DALTON
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Credential | M.D.
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Telephone | 336-759-7596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9500876
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24445
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9500759
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 102304
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101788
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101138
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 95-00876
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 95-00759
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 95-00876
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License Number State | NC
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Taxonomy #10
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 95-00759
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License Number State | NC
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