Organization
DOMENICK BRACCIA D.O.
Active
Other names
Haverford Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMENICK BRACCIA D.O. (MEDICAL DIRECTOR)
(610) 924-0600
Entity
Organization
Contact information
Practice address
2010 W CHESTER PIKE, SUITE 310, HAVERTOWN, PA 19083-2700
(610) 924-0600
(610) 924-0627
Mailing address
2010 W CHESTER PIKE, SUITE 310, HAVERTOWN, PA 19083-2700
(610) 924-0600
(610) 924-0627
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
OS006737L
PA
261QP3300X
Pain Clinic/Center
OS006737L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012371310008
—
PA
01
—
1794675
BLUE SHIELD
PA
01
—
648523
BLUE SHIELD
PA
Enumeration date
03/10/2009
Last updated
05/13/2009
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