Provider Demographics
NPI:1497876619
Name:BRANDYWINE CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BRANDYWINE CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NEUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-941-4433
Mailing Address - Street 1:PO BOX 828424
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8424
Mailing Address - Country:US
Mailing Address - Phone:610-941-3300
Mailing Address - Fax:
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012117340001Medicaid
PA0012117340001Medicaid