Healthcare Provider Details

I. General information

NPI: 1801843768
Provider Name (Legal Business Name): BRANDYWINE MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 13TH ST
WILMINGTON DE
19806-4054
US

IV. Provider business mailing address

1815 W 13TH ST
WILMINGTON DE
19806-4054
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-4705
  • Fax: 302-652-2917
Mailing address:
  • Phone: 302-652-4705
  • Fax: 302-652-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PASQUALE FUCCI
Title or Position: PRESIDENT
Credential: MD
Phone: 302-652-4705