MEDICARE: DR. DOMENICK BRACCIA DO

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
1	207Q00000X	Family Medicine Physician	0S006737L	PA
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	0S006737L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821178005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMENICK BRACCIA DO

Provider Business Mailing Address
First Line	:	1035 VIRGINIA DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034
Country	:	US
Telephone Number	:	267-419-7710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 VIRGINIA DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3103
Country	:	US
Telephone Number	:	267-419-7710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/17/2018

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