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General NPI Number Information
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NPI Number | 1326446063
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Entity Type | Individual
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Provider Name | ZACHARY BRAGANO PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR
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City | MORGANTOWN
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State | WV
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Zip | 26506-9238
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Country | US
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Telephone | 304-293-1272
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Fax |
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Provider Business Mailing Address
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Address Line | 121 DALE ST
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City | JEFFERSON HILLS
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State | PA
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Zip | 15025-3213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA057359
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License Number State | PA
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