Provider Demographics
NPI:1164432399
Name:DAILEY, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:DAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 OLD 421 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6293
Mailing Address - Country:US
Mailing Address - Phone:828-262-1011
Mailing Address - Fax:828-262-5695
Practice Address - Street 1:1879 OLD 421 SOUTH
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6293
Practice Address - Country:US
Practice Address - Phone:828-262-1011
Practice Address - Fax:828-262-5695
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135VGOtherBCBS
NC89135VGMedicaid
G90411Medicare UPIN
NC2021677AMedicare PIN