Provider Demographics
NPI:1396731147
Name:BRASKIE, MARIA T (PAC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:BRASKIE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1138
Mailing Address - Country:US
Mailing Address - Phone:610-377-8230
Mailing Address - Fax:610-377-7935
Practice Address - Street 1:211 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:610-377-8230
Practice Address - Fax:610-377-7935
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001308L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50044037OtherCBC
PA080690E6FMedicare PIN
PAR07523Medicare UPIN