MEDICARE: DR. MICHAEL JOHN DALY MD

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	208VP0014X	Interventional Pain Medicine Physician	D0055974	MD

General Provider Information

NPI Number	:	1194721753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN DALY MD

Provider Business Mailing Address
First Line	:	11350 MCCORMICK RD
Second Line	:	EXECUTIVE PLAZA 1, SUITE 501
City	:	HUNT VALLEY
State	:	MD
Zip	:	21031-1002
Country	:	US
Telephone Number	:	410-787-8316
Fax Number	:	410-787-8317

Provider Business Practice Location Address
First Line	:	1600 CRAIN HWY S
Second Line	:	SUITE 301
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5577
Country	:	US
Telephone Number	:	410-787-8315
Fax Number	:	410-787-8316

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	02/21/2017

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