Basic Information
| Provider Information | |||||||||
| NPI: | 1932132248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRANDYWINE UROLOGY CONSULTANTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 FOULK ROAD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026528990 | ||||||||
| FaxNumber: | 3026528646 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 FOULK ROAD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026528990 | ||||||||
| FaxNumber: | 3026528646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | GLICK | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3026528990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.