Provider Demographics
NPI:1760443543
Name:DALY, PATRICK W (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
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:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20116-0500
Mailing Address - Country:US
Mailing Address - Phone:877-641-2239
Mailing Address - Fax:781-276-6403
Practice Address - Street 1:11711 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5151
Practice Address - Country:US
Practice Address - Phone:540-364-2259
Practice Address - Fax:540-364-6033
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053117207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCH9140001OtherBLUE SHIELD
DC029597800Medicaid
MD76881001OtherBLUE SHIELD
MD028310001Medicaid
MD000K70G47Medicare ID - Type Unspecified
MDF94224Medicare UPIN