MEDICARE: MRS. KATHERINE DALTON MIKA 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	208000000X	Pediatrics Physician	0101040389	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010718	OTHER	VA	CIGNA
3	333852	OTHER	VA	ANTHEM
4	20028	OTHER	VA	VETRI
5	267171	OTHER	VA	MAMSI/ALLIANCE
6	12062400003	OTHER	VA	SOUTHERN HEALTH

General Provider Information

NPI Number	:	1326024373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE DALTON MIKA M.D.

Provider Business Mailing Address
First Line	:	3067 DARBY RD
Second Line	:
City	:	KESWICK
State	:	VA
Zip	:	22947-2720
Country	:	US
Telephone Number	:	434-984-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 INSURANCE LN
Second Line	:	SUITE A
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-7229
Country	:	US
Telephone Number	:	434-974-9600
Fax Number	:	434-296-1036

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	09/29/2012

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Directions to “ MRS. KATHERINE DALTON MIKA M.D.” Practice Location

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