Provider Demographics
NPI:1811590565
Name:FIRST STATE ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:FIRST STATE ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAEUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-731-2888
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:302-368-7756
Practice Address - Street 1:26744 JOHN J. WILLIAMS HWY
Practice Address - Street 2:STE 2
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-644-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STATE ORTHOPAEDICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-17
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology