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General NPI Number Information
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NPI Number | 1386380525
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Entity Type | Organization
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Legal Business Name | BRANDYWINE VALLEY TMS PA
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 2300 PENNSYLVANIA AVE STE 4C-1
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 646-755-5476
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Fax | 570-221-6246
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Provider Business Mailing Address
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Address Line | 1921 HICKORY HILL RD
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City | CHADDS FORD
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State | PA
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Zip | 19317-7333
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Country | US
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Telephone | 646-755-5476
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Fax | 570-221-6246
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Authorized Official
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Title or Position | OWNER
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Name | JACK CASTRO
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Credential | MD
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Telephone | 302-635-1710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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