Basic Information
Provider Information
NPI: 1922444884
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DALY
FirstName: KEVIN
MiddleName: PETER
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1101 SUMMIT RD
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452372621
CountryCode: US
TelephoneNumber: 5139483600
FaxNumber: 5139488631
Practice Location
Address1: 1101 SUMMIT RD
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452372621
CountryCode: US
TelephoneNumber: 5139483600
FaxNumber: 5139488631
Other Information
ProviderEnumerationDate: 05/20/2013
LastUpdateDate: 04/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X35.127699OHY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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