MEDICARE: DR. PHILIP F. DALY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	153064	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	153064	OTHER	MA	TUFTS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043207350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP F. DALY M.D.

Provider Business Mailing Address
First Line	:	300 BROADWAY 2ND FL
Second Line	:	MGH REVERE HEALTHCARE CENTER
City	:	REVERE
State	:	MA
Zip	:	02151
Country	:	US
Telephone Number	:	781-485-1000
Fax Number	:	781-286-5418

Provider Business Practice Location Address
First Line	:	300 BROADWAY
Second Line	:	2ND FL
City	:	REVERE
State	:	MA
Zip	:	02151-5009
Country	:	US
Telephone Number	:	781-485-1000
Fax Number	:	781-286-5418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2005
Last Update Date	:	07/08/2007

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