Provider Demographics
NPI:1578583142
Name:DALY, PATRICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:DALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RIVER ST.
Mailing Address - Street 2:HCRS
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4520
Practice Address - Street 1:49 SCHOOL ST.
Practice Address - Street 2:HCRS
Practice Address - City:HARTFORD
Practice Address - State:VT
Practice Address - Zip Code:05047
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-886-4520
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00106822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010324Medicaid
I00303Medicare UPIN
VN3327Medicare UPIN
100303Medicare PIN
VN0597Medicare ID - Type Unspecified