MEDICARE: WARREN I BRANDWINE D.O.

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	207V00000X	Obstetrics & Gynecology Physician	MB032448	NJ

General Provider Information

NPI Number	:	1871563163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN I BRANDWINE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 536
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-0536
Country	:	US
Telephone Number	:	856-669-6050
Fax Number	:	856-651-0794

Provider Business Practice Location Address
First Line	:	150 CENTURY PKWY
Second Line	:	SUITE A
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1129
Country	:	US
Telephone Number	:	856-778-1881
Fax Number	:	856-778-1572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	11/28/2007

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