Healthcare Provider Details

I. General information

NPI: 1972010924
Provider Name (Legal Business Name): FIRST STATE INFECTIOUS DISEASES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST SUITE 230
DOVER DE
19904-3487
US

IV. Provider business mailing address

200 BANNING ST SUITE 230
DOVER DE
19904-3487
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-0200
  • Fax: 302-678-2300
Mailing address:
  • Phone: 302-678-0200
  • Fax: 302-678-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC10005882
License Number StateDE

VIII. Authorized Official

Name: DR. REMESH VEMULAPALLI
Title or Position: MD
Credential: MD
Phone: 302-535-4608