Provider Demographics
NPI:1013165778
Name:FIRST STATE ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:FIRST STATE ORTHOPAEDICS PA
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF SOUTHERN DELAWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-451-6913
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:302-731-7049
Practice Address - Street 1:1539 SAVANNAH RD STE 203
Practice Address - Street 2:BAYVIEW MEDICAL CENTER
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1674
Practice Address - Country:US
Practice Address - Phone:302-644-3980
Practice Address - Fax:302-644-2804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STATE ORTHOPAEDICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-05
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1030265OtherAETNA US HEALTHCARE
510370286OtherONE NET PPO, MAMSI, OPTIMUM CHOICE, M.D. IPA
0848032000OtherAMERIHEALTH
51-0343207OtherBLUE CROSS BLUE SHIELD OF DELAWARE
510370286OtherCORVEL/CORCARE
510370286OtherGREAT WEST HEALTHCARE
510370286OtherRAILROAD MEDICARE
DE0000633502Medicaid
510370286OtherEASTERN SUSSEX PHYSICIANS ORGANIZATION, P.A.
510370286OtherUNITED HEALTHCARE
204885OtherUNISON HEALTH PLAN
510370286OtherCIGNA
510370286OtherDEVON HEALTH SERVICES
510370286OtherUNION LABOR LIFE INSURANCE COMPANY
510370286OtherHEALTH NET-TRICARE/CHAMPUS