Provider Demographics
NPI:1295009660
Name:FIRST STATE ENDOCRINOLOGY, PA
Entity Type:Organization
Organization Name:FIRST STATE ENDOCRINOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RIPUDAMAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUNDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-451-5610
Mailing Address - Street 1:774 CHRISTIANA RD STE 109
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4248
Mailing Address - Country:US
Mailing Address - Phone:302-444-8156
Mailing Address - Fax:302-731-8158
Practice Address - Street 1:774 CHRISTIANA RD STE 109
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4248
Practice Address - Country:US
Practice Address - Phone:302-444-8156
Practice Address - Fax:302-731-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1073591970Medicaid