Provider Demographics
NPI:1326040767
Name:GONZALEZ-BRAILE, DINAH (MD)
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:
Last Name:GONZALEZ-BRAILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12265 TOWNSEND ROAD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1214
Mailing Address - Country:US
Mailing Address - Phone:215-856-1010
Mailing Address - Fax:215-856-1060
Practice Address - Street 1:12265 TOWNSEND ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1214
Practice Address - Country:US
Practice Address - Phone:215-856-1010
Practice Address - Fax:215-856-1060
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047631L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032282970002Medicaid
PA557160Medicare PIN
NJ0595111OtherAETNA USHC
F89669Medicare UPIN
NJ3203016BOtherCIGNA HEALTHCARE
NJ333781OtherONE HEALTHPLAN
NJ15047OtherAMERIGROUP
NJ530505Medicare ID - Type Unspecified
NJF02048OtherHEALTHNET
NJ0734310000OtherAMERIHEALTH
NJ1050077OtherHORIZON NJ HEALTH
NJ1454834OtherUNITED HEALTHCARE
NJP418503OtherOXFORD HEALTHPLANS
NJ25813OtherUNIVERSITY HEALTHPLANS
NJ7284608Medicaid
NJ203268OtherUS FAMILY HEALTH