Provider Demographics
NPI:1164466983
Name:BRAVERMAN, DEBRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:MOSS BUILDING, THIRD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-342-2100
Mailing Address - Fax:215-342-6443
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:MOSS BUILDING, THIRD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-342-2100
Practice Address - Fax:215-342-6443
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059486L208100000X
NJ25MA05989100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG47856Medicare UPIN
PA902489PVJMedicare ID - Type Unspecified