MEDICARE: HENRY TUCKER DALTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	21925	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2296785	OTHER	VA	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	006279	OTHER	VA	ANTHEM BC/BS
4	5585	OTHER	VA	CAREFIRST BC/BS
5	2014566	OTHER	VA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1265462899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY TUCKER DALTON M.D.

Provider Business Mailing Address
First Line	:	3801 FAIRFAX DR
Second Line	:	SUITE 74
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1762
Country	:	US
Telephone Number	:	703-528-3910
Fax Number	:	703-528-4367

Provider Business Practice Location Address
First Line	:	3801 FAIRFAX DR
Second Line	:	SUITE 74
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1762
Country	:	US
Telephone Number	:	703-528-3910
Fax Number	:	703-528-4367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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Directions to “ HENRY TUCKER DALTON M.D.” Practice Location

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