Daly, Diane Dierdre

Daly, Diane Dierdre is an individual health care provider with primary practice located at 6119 W Jefferson Blvd , Fort Wayne IN 46804-3072. She recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as her primary health care specialty. Daly, Diane Dierdre can be contacted via phone (260) 432-1568.

Contact Information

Primary practice address
6119 W Jefferson Blvd Fort Wayne IN 46804-3072
Phone: (260) 432-1568
Fax: (260) 432-4969
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 01033743 Indiana

Profile Details

NPI number 1487625653
LBN Legal business name Daly, Diane Dierdre
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated Dec 16th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487625653 NPPES
Indiana MEDICAID 100348560
Indiana Other 300077574
Indiana MEDICAID 0787260
Indiana Other 300016185

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