Healthcare Provider Details

I. General information

NPI: 1396899472
Provider Name (Legal Business Name): FIRST STATE IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BEISER BLVD SUITE 201C
DOVER DE
19904-7790
US

IV. Provider business mailing address

71 HIDDEN VALLEY DR
NEWARK DE
19711-7463
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7246
  • Fax: 302-678-8890
Mailing address:
  • Phone: 302-734-7246
  • Fax: 302-678-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GANESH R BALU
Title or Position: PRESIDENT
Credential:
Phone: 302-734-7246