Healthcare Provider Details

I. General information

NPI: 1871663385
Provider Name (Legal Business Name): BRANDYWINE FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 SILVERSIDE RD
WILMINGTON DE
19810-4162
US

IV. Provider business mailing address

2106 SILVERSIDE RD
WILMINGTON DE
19810-4162
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-8099
  • Fax: 302-478-8717
Mailing address:
  • Phone: 302-478-8099
  • Fax: 302-478-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE-10000088
License Number StateDE

VIII. Authorized Official

Name: DR. LORI E LARUE
Title or Position: OWNER
Credential: DPM
Phone: 302-478-8099