Provider Demographics
NPI:1467438192
Name:DAILEY, CATHY ANNE (DO)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANNE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:3705 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104
Practice Address - Country:US
Practice Address - Phone:304-917-3530
Practice Address - Fax:304-917-3743
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340086272208000000X
WV1321208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0109065000Medicaid
OH2131053Medicaid
OH7421101Medicare PIN
F64285Medicare UPIN
OH000000392922OtherANTHEM
F64285Medicare UPIN