Provider Demographics
NPI:1235236860
Name:DAILEY, BRIAN DENNISON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DENNISON
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 1:2040 KENT RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:NY
Mailing Address - Zip Code:14477-9785
Mailing Address - Country:US
Mailing Address - Phone:585-764-7024
Mailing Address - Fax:
Practice Address - Street 1:60 BARRETT DR STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2963
Practice Address - Country:US
Practice Address - Phone:585-872-1003
Practice Address - Fax:585-872-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151125207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00719833Medicaid
NY00719833Medicaid
NYJ400125695/GRPBA0017Medicare PIN