Provider Demographics
NPI:1194721753
Name:DALY, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-787-8316
Mailing Address - Fax:410-787-8317
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-787-8315
Practice Address - Fax:410-787-8316
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
MDD0055974208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA658L91FFMedicare PIN
DC197568ZB0UMedicare PIN
MDB95358Medicare UPIN
MDB95358Medicare UPIN