Basic Information
| Provider Information | |||||||||
| NPI: | 1720058944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 BUTTRICK RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | LONDONDERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030533417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035371300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6 TSIENNETO RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035371300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9060 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0109438YPNH01 | 01 | NH | ANTHEM BLUECROSS | OTHER | 30006298 | 05 | NH | MEDICAID | 0706617 | 01 | NH | AETNA USHC | OTHER | 080093996 | 01 | NH | TRAVELERS MEDICARE | OTHER | F09042 | 01 | NH | HARVARD | OTHER | 404434 | 01 | NH | TUFTS | OTHER |