Provider Demographics
NPI:1598746562
Name:BRAGG, DANA EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:EUGENE
Last Name:BRAGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9327
Mailing Address - Country:US
Mailing Address - Phone:304-624-7111
Mailing Address - Fax:304-624-9267
Practice Address - Street 1:4 HOSPITAL PLZ
Practice Address - Street 2:SUITE 304
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9327
Practice Address - Country:US
Practice Address - Phone:304-624-7111
Practice Address - Fax:304-624-9267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0071747000Medicaid
WV0071747000Medicaid
0619184Medicare ID - Type Unspecified