Provider Demographics
NPI:1235186081
Name:BRANDYWINE HUNDRED FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:BRANDYWINE HUNDRED FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-5650
Mailing Address - Street 1:3521 SILVERSIDE RD
Mailing Address - Street 2:SUITE 2F1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4900
Mailing Address - Country:US
Mailing Address - Phone:302-478-5650
Mailing Address - Fax:302-477-0455
Practice Address - Street 1:3521 SILVERSIDE RD
Practice Address - Street 2:SUITE 2F1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4900
Practice Address - Country:US
Practice Address - Phone:302-478-5650
Practice Address - Fax:302-477-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE006525282724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty