Provider Demographics
NPI:1811943293
Name:DALEY, KRISTIN A (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:DALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1358 BOSTON POST RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1751
Mailing Address - Country:US
Mailing Address - Phone:843-723-3441
Mailing Address - Fax:843-805-4040
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:STE 420
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403
Practice Address - Country:US
Practice Address - Phone:843-723-3441
Practice Address - Fax:843-805-4040
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC27381207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC273812Medicaid
SCAA06651459Medicare PIN
I20016Medicare UPIN
SC273812Medicaid