Basic Information
| Provider Information | |||||||||
| NPI: | 1861469751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088982338 | ||||||||
| FaxNumber: | 5083669938 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015815408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088982338 | ||||||||
| FaxNumber: | 5083669938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 03/09/2018 | ||||||||
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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 | 208000000X | 49493 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 917638 | 01 | FIRST HEALTH | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 0776210 | 01 | CIGNA HEALTH PLAN | OTHER | 26737 | 01 | HEALTHY START | OTHER | 5459371 | 01 | AETNA US HEALTHCARE | OTHER | 110051949A | 05 | MA | MEDICAID | J02512 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 3099245 | 01 | MEDICAID WELFARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 9900120 | 01 | FALLON COMMUNITY HEALTH | OTHER | J02512 | 01 | BLUE SHIELD HMO BLUE | OTHER | 26737 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 784124 | 01 | MVP HEALTH CARE | OTHER | A02512 | 01 | MEDICARE B | OTHER | AA1257 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J02512 | 01 | BLUE CARE ELECT | OTHER |