Provider Demographics
NPI:1124214044
Name:FIRST STATE INFECTIOUS DISEASE SPECIALISTS LLC
Entity Type:Organization
Organization Name:FIRST STATE INFECTIOUS DISEASE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:HAUER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:302-661-2303
Mailing Address - Street 1:3301 LANCASTER PIKE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1436
Mailing Address - Country:US
Mailing Address - Phone:302-661-2303
Mailing Address - Fax:302-661-2324
Practice Address - Street 1:3301 LANCASTER PIKE
Practice Address - Street 2:SUITE 9
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1436
Practice Address - Country:US
Practice Address - Phone:302-661-2303
Practice Address - Fax:302-661-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DETP0003432174400000X
DE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000398601Medicaid
DE0000398601Medicaid
F16682Medicare UPIN