Provider Demographics
NPI:1295969616
Name:TOUSSAINT, BRIAN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:TOUSSAINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WAWASET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2142
Mailing Address - Country:US
Mailing Address - Phone:302-655-1500
Mailing Address - Fax:302-655-4084
Practice Address - Street 1:1700 WAWASET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2142
Practice Address - Country:US
Practice Address - Phone:302-655-1500
Practice Address - Fax:302-655-4084
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011273207WX0107X, 207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250596048Medicaid