MEDICARE: FIRST STATE MEDICAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C10004738	DE

General Provider Information

NPI Number	:	1033190145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STATE MEDICAL PA

Provider Business Mailing Address
First Line	:	3521 SILVERSIDE RD
Second Line	:	QUILLEN BUILDING SUITE 2D1
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4900
Country	:	US
Telephone Number	:	302-479-0555
Fax Number	:	302-479-5006

Provider Business Practice Location Address
First Line	:	3521 SILVERSIDE RD
Second Line	:	QUILLEN BUILDING SUITE 2D1
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4900
Country	:	US
Telephone Number	:	302-479-0555
Fax Number	:	302-479-5006

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. HUGH BONNER III
Credential	:	M.D.
Telephone Number	:	302-479-0555

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1740256692 — LAWRENCE G NARUN M.D.
Practice Location Address:

3521 SILVERSIDE RD , QUILLEN BLDG 1-C
WILMINGTON, DE
19810-4900

Practice Phone: 302-623-1929
Practice Fax: 302-366-1075

1619930708 — DR. DEBORAH TANYA ZAREK M.D.
Practice Location Address:

3521 SILVERSIDE RD STE 2J , CONCORD PLAZA, RIDGELY BLDG.
WILMINGTON, DE
19810-4900

Practice Phone: 302-543-5454
Practice Fax: 302-327-4200

1235186081 — BRANDYWINE HUNDRED FAMILY MEDICINE, LLC
Practice Location Address:

3521 SILVERSIDE RD , SUITE 2F1
WILMINGTON, DE
19810-4900

Practice Phone: 302-478-5650
Practice Fax: 302-477-0455

1124075585 — MS. ELIZABETH MILLS MS, RD, LDN
Practice Location Address:

3521 SILVERSIDE RD , CONCORD PLAZA QUILLEN BLDG, SUITE 2D1
WILMINGTON, DE
19810-4900

Practice Phone: 302-484-2035
Practice Fax: 302-482-2587

1013955251 — CHRISTINA MARIE LEHANE MD
Practice Location Address:

3521 SILVERSIDE RD STE 1F
WILMINGTON, DE
19810-4900

Practice Phone: 302-478-2613
Practice Fax:

1568473486 — DR. ILENE BOUDREAUX M.D.
Practice Location Address:

3521 SILVERSIDE RD , 1F QUILLEN BLDG
WILMINGTON, DE
19810-4900

Practice Phone: 302-479-5505
Practice Fax: 302-478-2637

Directions to “FIRST STATE MEDICAL PA ” Practice Location

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