Provider Demographics
NPI:1730274069
Name:BRANDYWINE PODIATRY, PA
Entity type:Organization
Organization Name:BRANDYWINE PODIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-658-1129
Mailing Address - Street 1:1010 NORTH BANCROFT PARKWAY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2668
Mailing Address - Country:US
Mailing Address - Phone:302-658-1129
Mailing Address - Fax:302-658-7646
Practice Address - Street 1:1010 NORTH BANCROFT PARKWAY
Practice Address - Street 2:SUITE 12
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2668
Practice Address - Country:US
Practice Address - Phone:302-658-1129
Practice Address - Fax:302-658-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000148850Medicaid
DE0000148850Medicaid
DEG02014Medicare PIN