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General NPI Number Information
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NPI Number | 1013165778
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Entity Type | Organization
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Legal Business Name | FIRST STATE ORTHOPAEDICS PA
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1539 SAVANNAH RD STE 203 BAYVIEW MEDICAL CENTER
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City | LEWES
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State | DE
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Zip | 19958-1674
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Country | US
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Telephone | 302-644-3980
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Fax | 302-644-2804
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Provider Business Mailing Address
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Address Line | 211 EXECUTIVE DR STE 11
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City | NEWARK
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State | DE
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Zip | 19702-3358
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Country | US
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Telephone | 302-731-2888
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Fax | 302-731-7049
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ARLEEN A AUKAMP
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Credential |
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Telephone | 302-451-6913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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