Provider Demographics
NPI:1114465812
Name:FIRST STATE ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:FIRST STATE ORTHOPAEDICS PA
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF SOUTHERN DELAWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-451-6913
Mailing Address - Street 1:211 EXECUTIVE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3358
Mailing Address - Country:US
Mailing Address - Phone:302-731-2888
Mailing Address - Fax:302-731-7049
Practice Address - Street 1:701 SAVANNAH RD STE B
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1550
Practice Address - Country:US
Practice Address - Phone:302-645-2805
Practice Address - Fax:302-645-1164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STATE ORTHOPAEDICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-02
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006103207X00000X
DEC10008726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184681488OtherCOMMERCIAL INSURANCES
DE0000633502Medicaid
DE0000633502Medicaid