Provider Demographics
NPI:1942815691
Name:FIRST STATE INFECTIOUS DISEASES, LLC
Entity Type:Organization
Organization Name:FIRST STATE INFECTIOUS DISEASES, LLC
Other - Org Name:FIRST STATE INFECTIOUS DISEASES LLC POIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-678-0200
Mailing Address - Street 1:200 BANNING STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3487
Mailing Address - Country:US
Mailing Address - Phone:302-678-0200
Mailing Address - Fax:302-678-2300
Practice Address - Street 1:200 BANNING STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3487
Practice Address - Country:US
Practice Address - Phone:302-678-0200
Practice Address - Fax:302-678-2300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STATE INFECTIOUS DISEASI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250444224Medicaid