Provider Demographics
NPI:1831175868
Name:DALEY, KATIE C (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:DALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:CAMPBELL
Other - Last Name:DALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:291 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-325-2800
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-325-2800
Practice Address - Fax:617-541-7500
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213895208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0026453OtherNEIGHBORHOOD HEALTH
MA204473OtherHARVARD PILGRIM
MA213895OtherTUFTS
MAJ24868OtherBLUE CROSS
MA204473OtherHARVARD PILGRIM
MA0170551Medicaid
MAJ24868OtherBLUE CROSS