Individual
DR. ROBERTA THERESA BRACKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4 JOHNSON RD, CHARLESTON, SC 29407-7515
(843) 556-1858
Mailing address
PO BOX 31175, CHARLESTON, SC 29417-1175
(843) 556-1858
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
07754
SC
Other
Enumeration date
10/23/2007
Last updated
10/23/2007
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