# DOMENICK BRACCIA D.O.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Haverford Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952542615
- **Authorized official:** DR. DOMENICK BRACCIA D.O. (MEDICAL DIRECTOR)
- **Authorized official phone:** (610) 924-0600

## Contact information

- **Practice address:** 2010 W CHESTER PIKE, SUITE 310, HAVERTOWN, PA 19083-2700
- **Practice address phone:** (610) 924-0600
- **Practice address fax:** (610) 924-0627
- **Mailing address:** 2010 W CHESTER PIKE, SUITE 310, HAVERTOWN, PA 19083-2700
- **Mailing address phone:** (610) 924-0600
- **Mailing address fax:** (610) 924-0627

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | OS006737L | PA | — |
| 261QI0500X | Infusion Therapy Clinic/Center | OS006737L | PA | — |
| 261QM1300X | Multi-Specialty Clinic/Center | OS006737L | PA | — |
| 261QM2500X | Medical Specialty Clinic/Center | OS006737L | PA | Yes |
| 261QP3300X | Pain Clinic/Center | OS006737L | PA | — |

## Other

- **Enumeration date:** 03/10/2009
- **Last updated:** 05/13/2009