Organization Active NPI

Brandywine Imaging Enterprises LLC

  • Diagnostic Radiology Physician
  • Wilmington, DE
National Provider Identifier
1720045214
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BRANDYWINE IMAGING ENTERPRISES LLC
Practice address
3206 Concord Pike
Wilmington, DE 19803-5015
Phone
(302) 654-5300
Fax
(302) 654-1967
NPI assigned
Apr 27, 2006
Last updated
Feb 23, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
DIA PRACTICE ENTERPRISES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victoria L Peacock, MS, MS
Title
Project Manager
Phone
(302) 993-2330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

3206 Concord Pike
Wilmington, DE 19803-5015

Mailing address

1601 Milltown Rd
Suite 13
Wilmington, DE 19808-4027
Phone (302) 993-2330

Other identifiers 1

IdentifierTypeStateIssuer
0000137202MedicaidDE

National Provider Directory

National Provider Directory

Locations

3206 Concord Pike
Wilmington, DE 19803
Phone (302) 654-5300

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1720045214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 MILLTOWN RD",
            "address_2": "SUITE 13",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198084027",
            "telephone_number": "302-993-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3206 CONCORD PIKE",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198035015",
            "telephone_number": "302-654-5300",
            "fax_number": "302-654-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDYWINE IMAGING ENTERPRISES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIA PRACTICE ENTERPRISES LLC",
        "enumeration_date": "2006-04-27",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "PEACOCK",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PROJECT MANAGER",
        "authorized_official_telephone_number": "302-993-2330",
        "authorized_official_credential": "MS, MS"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000137202",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.