MEDICARE: BRANDYWINE VALLEY INFECTIOUS DISEASES ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	MD052706L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760437529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDYWINE VALLEY INFECTIOUS DISEASES ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	213 REECEVILLE RD
Second Line	:	SUITE 27
City	:	COATESVILLE
State	:	PA
Zip	:	19320-1528
Country	:	US
Telephone Number	:	610-383-9333
Fax Number	:	610-383-1183

Provider Business Practice Location Address
First Line	:	213 REECEVILLE RD
Second Line	:	SUITE 27
City	:	COATESVILLE
State	:	PA
Zip	:	19320-1528
Country	:	US
Telephone Number	:	610-383-9333
Fax Number	:	610-383-1183

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAIDA RABAH
Credential	:	MD
Telephone Number	:	610-383-9999

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/28/2010

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