Brandywine Pediatrics, P.a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BRANDYWINE PEDIATRICS, P.A.

Practice address

3521 Silverside Rd
1F Quillen BLDG
Wilmington, DE 19810-4900

Phone

(302) 479-0294

Fax

(302) 478-2637

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ilene Boudreaux, M.D.

Title

President

Phone

(302) 479-0294

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ahila Lakshmi Kugan

  • Pediatrics Physician
  • Wilmington, DE
  • NPI 1346507134
  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912016155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 SILVERSIDE RD",
            "address_2": "1F QUILLEN BLDG",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198104900",
            "telephone_number": "302-479-0294",
            "fax_number": "302-478-2637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 SILVERSIDE RD",
            "address_2": "1F QUILLEN BLDG",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198104900",
            "telephone_number": "302-479-0294",
            "fax_number": "302-478-2637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDYWINE PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "ILENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "302-479-0294",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000684202",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandywine OBGYN, PA
• Brandywine Occupational Therapy, LLC
• Brandywine Optical Inc
• Brandywine Pain Management P a
• Brandywine Pediatric Dentistry, P.a.
• Brandywine Physical Therapy Services , Inc.
• Brandywine Podiatry PA
• Brandywine Podiatry PA
• Brandywine Podiatry, PA
• Brandywine Podiatry, PA

• Pediatrics Physician in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Pediatrics Physician in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.