Provider Demographics
NPI:1326057936
Name:BRANDYWINE INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:BRANDYWINE INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARRENER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:610-692-4382
Mailing Address - Street 1:531 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4416
Mailing Address - Country:US
Mailing Address - Phone:610-692-4382
Mailing Address - Fax:610-430-6820
Practice Address - Street 1:701 E BALTIMORE PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2400
Practice Address - Country:US
Practice Address - Phone:610-444-5630
Practice Address - Fax:610-444-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083314Medicare ID - Type Unspecified