Healthcare Provider Details

I. General information

NPI: 1487093282
Provider Name (Legal Business Name): MARY DALEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR FL 2
VOORHEES NJ
08043-9623
US

IV. Provider business mailing address

100 E PENN SQ FL 9
PHILADELPHIA PA
19107-3377
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number256114
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number25MA10901000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number256114
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA10901000
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD471811
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: