Provider Demographics
NPI:1083255392
Name:BRANDYWINE PODIATRY, PA
Entity Type:Organization
Organization Name:BRANDYWINE PODIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-658-1129
Mailing Address - Street 1:1010 N BANCROFT PKWY STE 12
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2668
Mailing Address - Country:US
Mailing Address - Phone:302-658-1129
Mailing Address - Fax:
Practice Address - Street 1:1501 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3615
Practice Address - Country:US
Practice Address - Phone:302-378-1022
Practice Address - Fax:302-378-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies