Individual
DR. DOMENICK BRACCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1035 VIRGINIA DR, FORT WASHINGTON, PA 19034-3103
(267) 419-7710
Mailing address
1035 VIRGINIA DR, FORT WASHINGTON, PA 19034
(267) 419-7710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0S006737L
PA
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
0S006737L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012371310008
—
PA
Enumeration date
10/16/2006
Last updated
03/17/2018
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