Provider Demographics
NPI:1043207350
Name:DALY, PHILIP F (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 BROADWAY 2ND FL
Mailing Address - Street 2:MGH REVERE HEALTHCARE CENTER
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:781-485-1000
Mailing Address - Fax:781-286-5418
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:2ND FL
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5009
Practice Address - Country:US
Practice Address - Phone:781-485-1000
Practice Address - Fax:781-286-5418
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA153064OtherTUFTS
MA3168808Medicaid
MAA22827Medicare ID - Type Unspecified
MA3168808Medicaid