Provider Demographics
NPI:1578503181
Name:DALY, ROBERT BELLARMINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BELLARMINE
Last Name:DALY
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 1:153 BOLIVIA ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2641
Mailing Address - Country:US
Mailing Address - Phone:860-208-4920
Mailing Address - Fax:
Practice Address - Street 1:153 BOLIVIA ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2641
Practice Address - Country:US
Practice Address - Phone:860-208-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0233472085R0202X
MA2352212085R0202X
NJ25MA110740002085R0202X
RIMD134092085R0202X
NH178122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001233477Medicaid
CTB38345Medicare UPIN