DOMENICK BRACCIA D.O. (NPI# 1952542615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952542615 |
| Entity Type | Organization |
| Organization Name | DOMENICK BRACCIA D.O. |
| Other Organization Name | HAVERFORD WELLNESS CENTER |
| Practice Address |
2010 W Chester Pike Suite 310 Havertown PA 19083-2700 |
| Practice Telephone | 6109240600 |
| Practice Fax Number | 6109240627 |
| Mailing Telephone | 6109240600 |
| Mailing Fax Number | 6109240627 |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2009-05-13 |
| Authorized Official Name | DR. DOMENICK BRACCIA (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6109240600 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
OS006737L | PA | Ambulatory Health Care Facilities |
| N | 261QI0500X |
Clinic/Center Specialization: Infusion Therapy |
OS006737L | PA | Ambulatory Health Care Facilities |
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
OS006737L | PA | Ambulatory Health Care Facilities |
| N | 261QP3300X |
Clinic/Center Specialization: Pain |
OS006737L | PA | Ambulatory Health Care Facilities |
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
OS006737L | PA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | BLUE SHIELD | 1794675 | 01 |
| PA | BLUE SHIELD | 648523 | 01 |
| PA | 0012371310008 | 05 |
| Other Name | Type Code |
|---|---|
| Haverford Wellness Center | Doing Business As Name - Organization |
| Street Address |
2010 W CHESTER PIKE SUITE 310 |
| City | HAVERTOWN |
| State | PA |
| Zip Code | 19083-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235130741 | Paul Ezell | Ophthalmology | 2010 W Chester Pike, Havertown, PA 19083-2700 | 2005-08-09 |
| 1033762430 | Maria Anne Spano | Counselor | 2010 W Chester Pike, Havertown, PA 19083-2700 | 2019-07-24 |
| 1811363393 | Ashlee Eileen Geier | Physical Therapist | 2010 W Chester Pike, Suite 450, Havertown, PA 19083-2700 | 2015-08-19 |
| 1053715458 | Stephanie Bergey | Counselor | 2010 W Chester Pike, Ste 314, Havertown, PA 19083-2700 | 2014-10-14 |
| 1053734970 | Daniel Brown | Counselor | 2010 W Chester Pike, Havertown, PA 19083-2700 | 2014-01-28 |
| 1801143201 | Bai Dan | Mechanotherapist | 2010 W Chester Pike, #407, Havertown, PA 19083-2700 | 2012-08-06 |
| 1689949067 | Richard L Jahnle Md PC | Optometrist | 2010 W Chester Pike, Wellness Center; Suite 310, Havertown, PA 19083-2737 | 2012-03-19 |
| 1619253812 | Lorene Renee Peta | Counselor | 2010 W Chester Pike, Suite 314, Havertown, PA 19083-2700 | 2011-11-01 |
| 1457636037 | Lll-usa Integrated Health Care Association | Clinic/Center | 2010 W Chester Pike, Suite 407, Havertown, PA 19083-2700 | 2011-10-14 |
| 1770896839 | Yu Jiang | Dentist | 2010 W Chester Pike, Suite 420, Havertown, PA 19083-2700 | 2010-07-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043835457 | Kelly Anne Clarke | Counselor | American Treatment Network Physician & Associates, 1120 Township Line Road, Havertown, PA 19083 | 2020-06-11 |
| 1588216238 | Angela Wrolstad | Registered Nurse | 614 Darby Road, Havertown, PA 19083 | 2019-07-12 |
| 1639696214 | Osaru Anyumba | Case Manager/Care Coordinator | 311 Lansdowne Road, Havertown, PA 19083 | 2017-08-24 |
| 1346762739 | Luke Francis Mattson | Pharmacist | 60 West Hillcrest Avenue, Havertown, PA 19083 | 2017-07-07 |
| 1124558150 | Clare M Chakey | Counselor | 1631 Ridgeway Road, Haventown, PA 19083 | 2017-06-13 |
| 1205382553 | Silverware Home Care Service LLC | Residential Treatment Facility, Physical Disabilities | 2010 Wester Chester Pike, Suite 448, Havertown, PA 19083 | 2016-08-28 |
| 1275903486 | Megan Keeley Ramaika | Dietitian, Registered | 404 Fairmont Road, Havertown, PA 19083 | 2015-09-30 |
| 1972987246 | Katie Paugh | Occupational Therapist | One North Belfield Avenue, Havertown, PA 19083 | 2015-07-16 |
| 1497140180 | Total Health Home Care Corporation | Nurse's Aide | 2710 West Township Line Rd, Havertown, PA 19083 | 2015-03-31 |
| 1851704084 | Ul Sik Jason Chong | Pharmacist | 700 East Townshipline Road Ste Ll, Havertown, PA 19083 | 2014-06-05 |
| Find all providers in zip 19083 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033408190 | Steven A Friedman, Md, PC | Clinic/Center | 850 W Chester Pike, Havertown, PA 19083-4400 | 2011-03-29 |
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| 1578043592 | Greater Pittston Urology | Clinic/Center | 250 Kennedy Blvd Ste 2, Pittston, PA 18640-1814 | 2018-08-20 |
| 1871953737 | Fulton County Medical Center | Clinic/Center | 622 Water St, Orbisonia, PA 17243-9424 | 2016-03-04 |
| 1962872861 | Mb Integrative Medicine LLC | Clinic/Center | 6782 Germantown Ave, Philadelphia, PA 19119-2110 | 2015-10-05 |
| 1437528817 | Charles S. Yanofsky, Md | Clinic/Center | 120 Pelham Rd, Camp Hill, PA 17011-1352 | 2015-09-16 |
| 1134597735 | Rheumatology Care Specialists | Clinic/Center | 1786 Wilmington Pike Ste 100b, Glen Mills, PA 19342-8122 | 2015-09-13 |
| 1346639861 | Seraly Eye Care Associates LLC | Clinic/Center | 220 E Mcmurray Rd, Mc Murray, PA 15317-2948 | 2015-01-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.