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NPI Code Detail

MEDICARE: DR. ENRICO BRAVO M.D.

MEDICARE: DR. ENRICO BRAVO M.D.
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
1207R00000XInternal Medicine Physician271901NY

General Provider Information

NPI Number : 1639497365
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ENRICO BRAVO M.D.
Provider Business Mailing Address
First Line : 47 NEW SCOTLAND AVE
Second Line : DEPARTMENT OF INTERNAL MEDICINE
City : ALBANY
State : NY
Zip : 12208-3412
Country : US
Telephone Number : 518-262-5377
Fax Number :
Provider Business Practice Location Address
First Line : 211 CHURCH ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-1090
Country : US
Telephone Number : 518-262-5377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2010
Last Update Date : 07/29/2020

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