1134109101 NPI number — DR. JOHN J DALY III M.D.

Table of content: DR. JOHN J DALY III M.D. (NPI 1134109101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134109101 NPI number — DR. JOHN J DALY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALY
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134109101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 EDGMONT AVE
Provider Second Line Business Mailing Address:
STE 1500
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-633-5840
Provider Business Mailing Address Fax Number:
302-633-5844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2502 SILVERSIDE RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-3740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-479-0500
Provider Business Practice Location Address Fax Number:
302-479-0599
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS007873L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: C2-0007134 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61684868 . This is a "BCBS OF DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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