| Keith Bravo, MD | |
|
651 Colliers Way Suite 502 Weirton WV 26062-5053 | |
| (304) 723-4328 | |
| Not Available |
| Full Name | Keith Bravo, MD |
|---|---|
| Speciality | Pediatrics |
| Location | 651 Colliers Way, Weirton, West Virginia |
| Authorized Official Name and Position | Keith Bravo (STAFF) |
| Authorized Official Contact | 3047234328 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Keith Bravo, MD Po Box 2581 Weirton WV 26062-1781 Ph: (304) 723-6040 | Keith Bravo, MD 651 Colliers Way Suite 502 Weirton WV 26062-5053 Ph: (304) 723-4328 |
| NPI Number | 1396949616 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 12/31/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396949616 | NPI | - | NPPES |
| 2147582 | Medicaid | OH | |
| 9298808 | Medicaid | OH | |
| 6000332000 | Medicaid | WV | |
| 0001352005 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 19983 (West Virginia) | Secondary |
| 208000000X | Pediatrics | 19983 (West Virginia) | Primary |
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