Provider Demographics
NPI:1235100371
Name:DALY, JOHN SF (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SF
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:191 CLARK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3400
Mailing Address - Country:US
Mailing Address - Phone:802-257-4265
Mailing Address - Fax:802-258-3809
Practice Address - Street 1:191 CLARK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3400
Practice Address - Country:US
Practice Address - Phone:802-257-4265
Practice Address - Fax:802-258-3809
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT0420008109208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT24P102OtherMVP
VT18882OtherBLUE CROSS BLUE SHIELD
VT0VN0579Medicaid
VT1002250Medicaid
VT18882OtherBLUE CROSS BLUE SHIELD
VN0579Medicare ID - Type Unspecified