Healthcare Provider Details

I. General information

NPI: 1801943824
Provider Name (Legal Business Name): BRANDYWINE PAIN MANAGEMENT P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 KIRKWOOD HWY SUITE 200
WILMINGTON DE
19808-5123
US

IV. Provider business mailing address

PO BOX 3012
WILMINGTON DE
19804-0012
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-2585
  • Fax: 302-998-3394
Mailing address:
  • Phone: 302-224-5678
  • Fax: 302-224-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: PRAMOD K YADHATI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-998-2585