Provider Demographics
NPI:1972389427
Name:BRANDYWINE THERAPEUTICS LLC
Entity Type:Organization
Organization Name:BRANDYWINE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, APRN
Authorized Official - Phone:302-256-7384
Mailing Address - Street 1:1309 VEALE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4609
Mailing Address - Country:US
Mailing Address - Phone:302-256-7384
Mailing Address - Fax:
Practice Address - Street 1:1309 VEALE RD STE 11
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4609
Practice Address - Country:US
Practice Address - Phone:302-256-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center