Basic Information
| Provider Information | |||||||||
| NPI: | 1558349167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRACONARO | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MAHANOY CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179482647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707733042 | ||||||||
| FaxNumber: | 5707733041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD014503E | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD014503E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0006357980005 | 05 | PA | MEDICAID | 50046146 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 152308 | 01 | PA | BLUE SHIELD | OTHER |