Healthcare Provider Details

I. General information

NPI: 1043918824
Provider Name (Legal Business Name): FIRST STATE ORTHOPAEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 TOWER LN STE 201
MIDDLETOWN DE
19709-1763
US

IV. Provider business mailing address

211 EXECUTIVE DR STE 11
NEWARK DE
19702-3358
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-2888
  • Fax:
Mailing address:
  • Phone: 302-731-2888
  • Fax: 302-731-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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