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Organization

BRAVO MEDICAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK GALLIHUE (CORP DIR OF PATIENT ACCOUNTS)
(610) 994-2968
Entity
Organization

Contact information

Practice address
10 SOMERDALE SQUARE 1200 SOUTH WHITE HORSE PIKE, SOMERDALE, NJ 08083-1345
(856) 679-2500
Mailing address
2701 RENAISSANCE BLVD FL 4, KING OF PRUSSIA, PA 19406-2781
(610) 994-2968

Taxonomy

Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary

Other

Enumeration date
08/01/2019
Last updated
08/01/2019
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