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General NPI Number Information
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NPI Number | 1952542615
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Entity Type | Organization
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Legal Business Name | DOMENICK BRACCIA D.O.
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 2010 W CHESTER PIKE SUITE 310
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City | HAVERTOWN
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State | PA
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Zip | 19083-2700
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Country | US
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Telephone | 610-924-0600
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Fax | 610-924-0627
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Provider Business Mailing Address
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Address Line | 2010 W CHESTER PIKE SUITE 310
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City | HAVERTOWN
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State | PA
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Zip | 19083-2700
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Country | US
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Telephone | 610-924-0600
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Fax | 610-924-0627
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DOMENICK BRACCIA
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Credential | D.O.
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Telephone | 610-924-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | OS006737L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | OS006737L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | OS006737L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | OS006737L
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | OS006737L
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License Number State | PA
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