Provider Demographics
| NPI: | 1184681488 |
|---|---|
| Name: | FIRST STATE ORTHOPAEDICS PA |
| Entity type: | Organization |
| Organization Name: | FIRST STATE ORTHOPAEDICS PA |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| 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 DRIVE |
| Mailing Address - Street 2: | SUITE 211 |
| 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: | 12100 BLACK SWAN DRIVE |
| Practice Address - Street 2: | SUITE 201 |
| Practice Address - City: | LEWES |
| Practice Address - State: | DE |
| Practice Address - Zip Code: | 19958-4988 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 302-644-3311 |
| Practice Address - Fax: | 302-644-3300 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | FIRST STATE ORTHOPAEDICS PA |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-04-28 |
| Last Update Date: | 2023-12-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207L00000X, 207LP2900X, 208100000X, 2086S0105X, 213E00000X, 213ES0103X, 363A00000X, 207X00000X | ||
| DE | 207X00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2086S0105X | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | Group - Multi-Specialty |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 51-0370286 | Other | RAILROAD MEDICARE | |
| 51-0370286 | Other | CORVEL/CORCARE | |
| 51-0370286 | Other | UNITED HEALTHCARE | |
| 51-0370286 | Other | GREAT-WEST HEALTHCARE | |
| 51-0370286 | Other | HEALTH NET - TRICARE/CHAMPUS | |
| 0848032000 | Other | AMERIHEALTH | |
| 51-0370286 | Other | CIGNA | |
| 51-0370286 | Other | ONENET PPO , MAMSI, OPTIMUM CHOICE | |
| 1030265 | Other | AETNA US HEALTHCARE | |
| 204885 | Other | UNISON HEALTH PLAN | |
| 51-0343207 | Other | BLUE CROSS BLUE SHIELD OF DELAWARE | |
| 51-0370286 | Other | DEVON HEALTH SERVICES | |
| DE | 51-0370286 | Other | EASTERN SUSSEX PHYSICIANS ORGANIZATION |
| DE | 0000633502 | Medicaid | |
| 51-0370286 | Other | UNION LABOR LIFE INSURANCE |
