Provider Demographics
NPI:1174519599
Name:DALY, BRIEN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:BRIEN
Middle Name:PATRICK
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN ST # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:617-499-5054
Mailing Address - Fax:
Practice Address - Street 1:134 SOUTH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493
Practice Address - Country:US
Practice Address - Phone:781-893-2224
Practice Address - Fax:781-891-1041
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74793207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3130151Medicaid
MAJ12965Medicare ID - Type Unspecified
MA3130151Medicaid