Provider Demographics
NPI:1972010924
Name:FIRST STATE INFECTIOUS DISEASES, LLC
Entity Type:Organization
Organization Name:FIRST STATE INFECTIOUS DISEASES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:REMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-535-4608
Mailing Address - Street 1:200 BANNING ST
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 ST
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005882207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2504442244Medicaid