Provider Demographics
NPI:1356693394
Name:FIRST STATE INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:FIRST STATE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDELWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-753-8204
Mailing Address - Street 1:1208 HURLOCK CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4960
Mailing Address - Country:US
Mailing Address - Phone:302-261-2269
Mailing Address - Fax:302-834-2184
Practice Address - Street 1:102 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5841
Practice Address - Country:US
Practice Address - Phone:302-261-2269
Practice Address - Fax:302-834-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-14
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2012605820261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty