Provider Demographics
NPI:1568753978
Name:DALY, IAN TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:TREVOR
Last Name:DALY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:FAMILY CARE MEDICAL GROUP, STE. 109N
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-487-1573
Mailing Address - Fax:315-487-2418
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:FAMILY CARE MEDICAL GROUP, STE. 109N
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-487-1573
Practice Address - Fax:315-487-2418
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2014-06-04
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Provider Licenses
StateLicense IDTaxonomies
NY63069207Q00000X
NY272973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine