NPI Code Detail JSON Logo

1952542615 NPI number — DOMENICK BRACCIA D.O.

NPI Number: 1952542615
Health Care Provider/Practitioner: DOMENICK BRACCIA D.O.

Information about “1952542615” NPI (DOMENICK BRACCIA D.O.) exists in 1952542615 in HTML format HTML  |  1952542615 in plain Text format TXT  |  1952542615 in PDF (Portable Document Format) PDF  |  1952542615 in an XML format XML  formats.

NPI Number : 1952542615 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952542615",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DOMENICK BRACCIA D.O.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2010 W CHESTER PIKE",
    "SecondLineMailingAddress": "SUITE 310",
    "MailingAddressCityName": "HAVERTOWN",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19083-2700",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-924-0600",
    "MailingAddressFaxNumber": "610-924-0627",
    "FirstLinePracticeLocationAddress": "2010 W CHESTER PIKE",
    "SecondLinePracticeLocationAddress": "SUITE 310",
    "PracticeLocationAddressCityName": "HAVERTOWN",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19083-2700",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "610-924-0600",
    "PracticeLocationAddressFaxNumber": "610-924-0627",
    "EnumerationDate": "03/10/2009",
    "LastUpdateDate": "05/13/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BRACCIA",
    "AuthorizedOfficialFirstName": "DOMENICK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.O.",
    "AuthorizedOfficialTelephoneNumber": "610-924-0600",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": "OS006737L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QI0500X",
          "TaxonomyName": "Infusion Therapy Clinic/Center",
          "LicenseNumber": "OS006737L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": "OS006737L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP3300X",
          "TaxonomyName": "Pain Clinic/Center",
          "LicenseNumber": "OS006737L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM2500X",
          "TaxonomyName": "Medical Specialty Clinic/Center",
          "LicenseNumber": "OS006737L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.