1760443543 NPI number — PATRICK W DALY MD

Table of content: PATRICK W DALY MD (NPI 1760443543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760443543 NPI number — PATRICK W DALY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALY
Provider First Name:
PATRICK
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760443543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20116-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-641-2239
Provider Business Mailing Address Fax Number:
781-276-6403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11711 LIVINGSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WASHINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20744-5151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-364-2259
Provider Business Practice Location Address Fax Number:
540-364-6033
Provider Enumeration Date:
03/31/2006

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: 207P00000X , with the licence number:  D0053117 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: H9140001 . This is a "BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 029597800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76881001 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 028310001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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