Provider Demographics
NPI:1699747311
Name:BRAVOCO, MICHAEL C (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BRAVOCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0536
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-651-0794
Practice Address - Street 1:599 SHORE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2400
Practice Address - Country:US
Practice Address - Phone:609-926-8353
Practice Address - Fax:609-926-4579
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA039936207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56562Medicare UPIN
NJ509187N5VMedicare PIN