Healthcare Provider Details

I. General information

NPI: 1932132248
Provider Name (Legal Business Name): BRANDYWINE UROLOGY CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOULK RD STE F
WILMINGTON DE
19810-3642
US

IV. Provider business mailing address

12 READS WAY STE 2000
NEW CASTLE DE
19720-1649
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-8990
  • Fax: 302-652-8646
Mailing address:
  • Phone: 302-652-8990
  • Fax: 302-652-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW J GLICK
Title or Position: OWNER
Credential:
Phone: 302-652-8417