Healthcare Provider Details

I. General information

NPI: 1902950603
Provider Name (Legal Business Name): FIRST STATE ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 OGLETOWN STANTON RD SUITE 100
NEWARK DE
19713-2081
US

IV. Provider business mailing address

PO BOX 6385
WILMINGTON DE
19804-0985
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-2380
  • Fax: 302-225-2388
Mailing address:
  • Phone: 302-225-2380
  • Fax: 302-225-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THIRUMALESHAWAR KANCHANA
Title or Position: PHYSICIAN COORDINATOR
Credential: M.D.
Phone: 302-225-2380