Provider Demographics
NPI:1770662397
Name:DAILEY, PENELOPE (MD)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2185 WEST 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1049
Mailing Address - Country:US
Mailing Address - Phone:814-464-8311
Mailing Address - Fax:814-464-8462
Practice Address - Street 1:2910 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1832
Practice Address - Country:US
Practice Address - Phone:814-454-5686
Practice Address - Fax:814-454-8946
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052279L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001621053Medicaid
PAG21647Medicare UPIN
PA833772Medicare ID - Type Unspecified