Provider Demographics
NPI:1407897846
Name:DALEY, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:DALEY
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8749
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-235-3447
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110081945OtherPALMETTO GBA PROVIDER#
NC8926758Medicaid
NC0403984OtherEVERCARE
NCFH1000085OtherFIRSTCAROLINACARE PROV.#
SCQ25009OtherSC MEDICAID PROVIDER#
NC22699OtherMEDCOST PROVIDER#
NC26758OtherBC/BS NC PROVIDER#
NC110081945OtherPALMETTO GBA PROVIDER#
NC26758OtherBC/BS NC PROVIDER#