Provider Demographics
NPI:1962588335
Name:BRALOW, VICKI L (DO)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:BRALOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W WASHINGTON SQ APT 3707
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3538
Mailing Address - Country:US
Mailing Address - Phone:215-832-0135
Mailing Address - Fax:610-660-0877
Practice Address - Street 1:834 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2025
Practice Address - Country:US
Practice Address - Phone:215-832-0135
Practice Address - Fax:610-660-0877
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S006570L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
466236Medicare ID - Type Unspecified
E69312Medicare UPIN