Provider Demographics
NPI:1700907474
Name:BRACCIA, GREGORY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:BRACCIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1591 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3224
Mailing Address - Country:US
Mailing Address - Phone:610-326-8005
Mailing Address - Fax:610-327-9629
Practice Address - Street 1:1591 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3224
Practice Address - Country:US
Practice Address - Phone:610-326-8005
Practice Address - Fax:610-327-9629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD048926207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
745061Medicare PIN