Provider Demographics
NPI:1982762696
Name:BRANDYWINE WOMENS HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:BRANDYWINE WOMENS HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-658-3331
Mailing Address - Street 1:611 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-4707
Mailing Address - Country:US
Mailing Address - Phone:302-658-3331
Mailing Address - Fax:302-658-9306
Practice Address - Street 1:611 W 18TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4707
Practice Address - Country:US
Practice Address - Phone:302-658-3331
Practice Address - Fax:302-658-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2334998000OtherAMERIHEALTH
DE001658755OtherHIGHMARK BLUE SHIELD
DE1000039438Medicaid