Provider Demographics
NPI:1174504864
Name:DALEY RICHARDS, PAULINE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:MARIA
Last Name:DALEY RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:MARIA
Other - Last Name:DALEY-RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:443-849-3760
Mailing Address - Fax:443-849-8138
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:443-849-3760
Practice Address - Fax:443-849-8138
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46795Medicare UPIN