MEDICARE: BRANDYWINE HUNDRED FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	006525282724	DE

General Provider Information

NPI Number	:	1235186081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDYWINE HUNDRED FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	3521 SILVERSIDE RD
Second Line	:	SUITE 2F1
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4900
Country	:	US
Telephone Number	:	302-478-5650
Fax Number	:	302-477-0455

Provider Business Practice Location Address
First Line	:	3521 SILVERSIDE RD
Second Line	:	SUITE 2F1
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4900
Country	:	US
Telephone Number	:	302-478-5650
Fax Number	:	302-477-0455

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JUDITH C WOLLMAN
Credential	:	M.D.
Telephone Number	:	302-478-5650

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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Directions to “BRANDYWINE HUNDRED FAMILY MEDICINE, LLC ” Practice Location

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