Provider Demographics
NPI:1053362764
Name:BRACCIANO DERMATOLOGY PLC
Entity type:Organization
Organization Name:BRACCIANO DERMATOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRACCIANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:941-360-2255
Mailing Address - Street 1:6539 FLYCATCHER LN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8269
Mailing Address - Country:US
Mailing Address - Phone:941-360-2255
Mailing Address - Fax:
Practice Address - Street 1:8430 COOPER CREEK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201
Practice Address - Country:US
Practice Address - Phone:941-360-2255
Practice Address - Fax:941-487-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7345207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9833Medicare ID - Type Unspecified