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Individual

DR. TIMOTHY JOHN DALTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1995 BETHABARA RD, WINSTON-SALEM, NC 27106-3375
(336) 759-7596
(336) 759-3652
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 759-7596
(336) 759-3652

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9500876
NC
207R00000X
Internal Medicine Physician
Primary
95-00876
NC
208000000X
Pediatrics Physician
95-00876
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0402121
UNITED HEALTHCARE
01
10526
PARTNERS
01
110113235
RAILROAD MEDICARE
01
2624358
AETNA HMO OPOS
01
26793
BCBS
01
287316
MAMSI
01
410250659
CHAMPUS
01
5592041
AETNA PPO POS
01
58523
MEDCOST
05
8926793
NC
Enumeration date
05/27/2005
Last updated
10/28/2020
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