Healthcare Provider Details

I. General information

NPI: 1770662397
Provider Name (Legal Business Name): PENELOPE DAILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PENELOPE CHAPMAN M.D.

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 STATE ST
ERIE PA
16508-1832
US

IV. Provider business mailing address

2185 WEST 8TH ST
ERIE PA
16505-1049
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-5686
  • Fax: 814-454-8946
Mailing address:
  • Phone: 814-464-8311
  • Fax: 814-464-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD052279L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: