Provider Demographics
NPI:1962440388
Name:JOHN J DALY, III, D.O., PC
Entity Type:Organization
Organization Name:JOHN J DALY, III, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-479-0500
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:2502 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3740
Practice Address - Country:US
Practice Address - Phone:302-479-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0007134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE61684868OtherBCBS OF DE
DEG01688Medicare ID - Type Unspecified
DEF88181Medicare UPIN