Provider Demographics
NPI:1215054523
Name:SCOTT A. BRALOW D.B.A NEPHROLOGY CONSULTANTS
Entity type:Organization
Organization Name:SCOTT A. BRALOW D.B.A NEPHROLOGY CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRALOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-660-8864
Mailing Address - Street 1:301 CITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1738
Mailing Address - Country:US
Mailing Address - Phone:610-660-8864
Mailing Address - Fax:610-660-0877
Practice Address - Street 1:301 CITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1738
Practice Address - Country:US
Practice Address - Phone:610-660-8864
Practice Address - Fax:610-660-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006582-L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE82438Medicare UPIN
PA552065Medicare ID - Type Unspecified
PA586798JG0Medicare PIN