Provider Demographics
NPI:1790998979
Name:BRAVERMAN, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BRAVERMAN
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 1:2221 ENBORG LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2608
Mailing Address - Country:US
Mailing Address - Phone:408-885-6220
Mailing Address - Fax:408-885-3977
Practice Address - Street 1:2221 ENBORG LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2608
Practice Address - Country:US
Practice Address - Phone:408-885-6220
Practice Address - Fax:408-885-3977
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA888232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GJ622XMedicare UPIN
GJ622PMedicare UPIN
GJ622YMedicare UPIN
CA00A888231Medicare PIN
GJ622ZMedicare UPIN
GJ622QMedicare UPIN
GJ622RMedicare UPIN
CAI21264Medicare UPIN
GJ622VMedicare UPIN
GJ622SMedicare UPIN
GJ622TMedicare UPIN
GJ622UMedicare UPIN
GJ622WMedicare UPIN
CA00A888230Medicare PIN