Provider Demographics
NPI:1043323900
Name:BRANDYWINE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:BRANDYWINE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-475-3131
Mailing Address - Street 1:1805 FOULK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3700
Mailing Address - Country:US
Mailing Address - Phone:302-475-3131
Mailing Address - Fax:
Practice Address - Street 1:1805 FOULK RD
Practice Address - Street 2:SUITE G
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3700
Practice Address - Country:US
Practice Address - Phone:302-475-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001166804Medicaid
DE0001166804Medicaid