Provider Demographics
NPI:1831361641
Name:BRAUNLICH ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:BRAUNLICH ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:FRITZ
Authorized Official - Last Name:BRAUNLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-242-9460
Mailing Address - Street 1:2000 EOFF STREET
Mailing Address - Street 2:SUITE 604
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6391
Mailing Address - Country:US
Mailing Address - Phone:304-312-2216
Mailing Address - Fax:304-231-3850
Practice Address - Street 1:2000 EOFF STREET
Practice Address - Street 2:SUITE 604
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6391
Practice Address - Country:US
Practice Address - Phone:304-312-2216
Practice Address - Fax:304-231-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22872207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2946049Medicaid
WV11832445OtherCAQH
WV3810012425Medicaid
WV1205811130OtherINDIVIDUAL NPI
OH2946049Medicaid
OH2946049Medicaid