Dr. Domenick Braccia, DO
Family Medicine, Addiction Medicine in Fort Washington, PA. Individual provider (NPI-1).
NPI number1821178005
StatusActive
Last updated in NPPESMar 17, 2018
Details
- NPI
- 1821178005
- Entity type
- Individual (NPI-1)
- Name
- Dr. Domenick Braccia
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 16, 2006
- Last updated
- Mar 17, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- Medicare opt-out
- Jul 1, 2015 to Jul 1, 2027
- OIG exclusion list
- Excluded since Oct 20, 2020 (1128a3)
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0401X | Family Medicine, Addiction Medicine | 0S006737L | PA | Yes |
| 207Q00000X | Family Medicine | 0S006737L | PA |
Practice location
1035 Virginia DrFort Washington, PA 19034-3103
Phone 267-419-7710
Mailing address
1035 Virginia DrFort Washington, PA 19034
Phone 267-419-7710
Other practice locations
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Other Addiction Medicine (Family Medicine) Physician providers in Fort Washington, PA
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