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General NPI Number Information
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NPI Number | 1023556875
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Entity Type | Organization
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Legal Business Name | BRALOW MEDICAL GROUP
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 834 SOUTH ST.
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City | PHILADELPHIA
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State | PA
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Zip | 19147
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Country | US
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Telephone | 610-986-4827
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Fax | 610-660-0877
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Provider Business Mailing Address
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Address Line | 834 SOUTH STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19147
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Country | US
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Telephone | 610-986-4827
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Fax | 610-660-0877
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICKI L BRALOW
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Credential | D.O.
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Telephone | 610-986-4827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS006570L
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License Number State | PA
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