Provider Demographics
NPI:1376600932
Name:FIRST STATE PODIATRY, L.L.C.
Entity Type:Organization
Organization Name:FIRST STATE PODIATRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOLGADO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-678-4612
Mailing Address - Street 1:1177 S GOVERNORS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6903
Mailing Address - Country:US
Mailing Address - Phone:302-678-4612
Mailing Address - Fax:302-678-4614
Practice Address - Street 1:1177 S GOVERNORS AVE STE B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6903
Practice Address - Country:US
Practice Address - Phone:302-678-4612
Practice Address - Fax:302-678-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000139213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02537Medicare PIN
DEU78794Medicare UPIN
DE5930460001Medicare NSC