Provider Demographics
NPI:1689654980
Name:DALY, MARY E (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:DALY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:25 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6708
Mailing Address - Country:US
Mailing Address - Phone:603-695-2572
Mailing Address - Fax:
Practice Address - Street 1:25 S RIVER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6708
Practice Address - Country:US
Practice Address - Phone:603-695-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN358657000Medicaid
MN358657000Medicaid
MNH89352Medicare UPIN
NH000044802Medicare PIN