Provider Demographics
NPI:1649224957
Name:DAILEY, ELLEN E (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:DAILEY
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 1:100 PEACH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-452-0026
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-459-1851
Practice Address - Fax:814-452-0026
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024855E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011091960008Medicaid
PA421583OtherHIGHMARK BC/BS
160024709OtherRAILROAD MEDICARE
PA0011091960008Medicaid
PA0011091960008Medicaid