Provider Demographics
NPI:1588776041
Name:BRAVERMAN, ALIZA S (MD)
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:S
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N 15TH ST
Mailing Address - Street 2:6TH FLOOR STE. 6144 MS 426
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1101
Mailing Address - Country:US
Mailing Address - Phone:215-762-8252
Mailing Address - Fax:215-246-5913
Practice Address - Street 1:245 N 15TH ST
Practice Address - Street 2:6TH FLOOR STE. 6144 MS 426
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-8252
Practice Address - Fax:215-246-5913
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437729207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3825130Medicaid
AR84169OtherBCBS AR
AR162826001Medicaid
MO206279309Medicaid
7129867OtherAETNA
MS08674874Medicaid
TN4136487OtherBCBS TN
TNP00372259Medicare PIN
7129867OtherAETNA
TN3825130Medicare PIN