Provider Demographics
NPI:1700306545
Name:DALEY, JOEL (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DALEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 EDWARDS RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1678
Mailing Address - Country:US
Mailing Address - Phone:513-981-4646
Mailing Address - Fax:513-979-2830
Practice Address - Street 1:4101 EDWARDS RD FL 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1678
Practice Address - Country:US
Practice Address - Phone:513-981-4646
Practice Address - Fax:513-979-2830
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014377207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program