Healthcare Provider Details

I. General information

NPI: 1124236948
Provider Name (Legal Business Name): FIRST STATE ORTHOPAEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 SOUTH QUEEN ST SUITE 2
DOVER DE
19904
US

IV. Provider business mailing address

4745 OGLETOWN-STANTON RD SUITE 225
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-7700
  • Fax:
Mailing address:
  • Phone: 302-731-2888
  • Fax: 302-368-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number562752
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: DAVID BLAEVER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 302-731-2888