MEDICARE: DINAH GONZALEZ-BRAILE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	MD047631L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326040767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINAH GONZALEZ-BRAILE MD

Provider Business Mailing Address
First Line	:	12265 TOWNSEND ROAD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1214
Country	:	US
Telephone Number	:	215-856-1010
Fax Number	:	215-856-1060

Provider Business Practice Location Address
First Line	:	12265 TOWNSEND ROAD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1214
Country	:	US
Telephone Number	:	215-856-1010
Fax Number	:	215-856-1060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/24/2017

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