Provider Demographics
NPI:1992863856
Name:BRANDYWINE VALLEY FAMILY CARE
Entity Type:Organization
Organization Name:BRANDYWINE VALLEY FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FAHNESTOCK
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-255-4466
Mailing Address - Street 1:20 MCMASTER BOULEVARD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KEMBLESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19347-0400
Mailing Address - Country:US
Mailing Address - Phone:610-255-4466
Mailing Address - Fax:610-255-4479
Practice Address - Street 1:20 MCMASTER BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:KEMBLESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19347-0400
Practice Address - Country:US
Practice Address - Phone:610-255-4466
Practice Address - Fax:610-255-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA207Q00000XOtherTAXONOMY #
PA207Q00000XOtherTAXONOMY #