Provider Demographics
NPI:1790762946
Name:DALY, CHARLES PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PAUL
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000302882085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA155036OtherL&I PROVIDER NUMBER
WA8159824Medicaid
WA115847OtherL&I PROVIDER NUMBER
WAGAB25171Medicare PIN
WA8159824Medicaid
WAGAB03738Medicare PIN
WAG8926575Medicare PIN
WA300085637Medicare PIN
WAG8893303Medicare PIN
WA115847OtherL&I PROVIDER NUMBER
WA155036OtherL&I PROVIDER NUMBER
WAF88609Medicare UPIN
WAAB02921Medicare PIN