Provider Demographics
NPI:1124207865
Name:GREGORY M BRACCIA MD LLC
Entity Type:Organization
Organization Name:GREGORY M BRACCIA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCARDUZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-452-8003
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-0546
Mailing Address - Country:US
Mailing Address - Phone:484-452-8003
Mailing Address - Fax:610-879-5129
Practice Address - Street 1:945 CHESTERBROOK BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5614
Practice Address - Country:US
Practice Address - Phone:610-695-8088
Practice Address - Fax:610-695-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0489261208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty