Healthcare Provider Details

I. General information

NPI: 1003074006
Provider Name (Legal Business Name): TIMOTHY MATTHEW DALY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ROUTE 113
SOUDERTON PA
18964-1000
US

IV. Provider business mailing address

777 ROUTE 113
SOUDERTON PA
18964-1000
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-3280
  • Fax: 215-723-5503
Mailing address:
  • Phone: 215-723-3280
  • Fax: 215-723-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS015738
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: