Provider Demographics
NPI:1275546871
Name:BRANDYWINE FAMILY FOOT CARE P C
Entity Type:Organization
Organization Name:BRANDYWINE FAMILY FOOT CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PONGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-383-5220
Mailing Address - Street 1:213 REECEVILLE RD STE 13
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1539
Mailing Address - Country:US
Mailing Address - Phone:610-383-5220
Mailing Address - Fax:610-383-0390
Practice Address - Street 1:213 REECEVILLE RD STE 13
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1539
Practice Address - Country:US
Practice Address - Phone:610-383-5220
Practice Address - Fax:610-383-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA572233OtherBLUE SHIELD
PA480025672OtherRAIL ROAD MEDICARE
PA572233OtherBLUE SHIELD
PAT30548Medicare UPIN
PA122475Medicare PIN