National Provider Identifier Database

DOMENICK BRACCIA DO
Medical Specialty

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).


Contact Information

DOMENICK BRACCIA D.O.
2010 W CHESTER PIKE
SUITE 310
HAVERTOWN, PA19083-2700
Phone: 610-924-0600
Fax: 610-924-0627
Website:
Specialty Taxonomy Code
* Medical Specialty 261QM2500X
Health Service 261QH0100X
Infusion Therapy 261QI0500X
Multi-Specialty 261QM1300X
Pain 261QP3300X

* Indicates primary specialty

NPI Profile & details for DOMENICK BRACCIA D.O.

NPI Number 1952542615
Legal business name
LBN
DOMENICK BRACCIA D.O.
Authorized official DOMENICK BRACCIA - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 03/10/2009
Last updated 05/13/2009 - About 17 years ago
Sole proprietor1 Not specified
Identifiers
  • PA License #: OS006737L
  • PA Medicaid: 0012371310008
  • PA Other: 1794675 BLUE SHIELD
  • PA Other: 648523 BLUE SHIELD

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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