Provider Demographics
NPI:1174586358
Name:BRALOW, SCOTT A (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:BRALOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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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:19004-1708
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:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-660-8864
Practice Address - Fax:610-660-0877
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-006582-L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA552065OtherMEDICARE ID
PA586798JG0Medicare PIN
PAE82438Medicare UPIN