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NPI Code Detail

MEDICARE: FIRST STATE MEDICAL PA

MEDICARE: FIRST STATE MEDICAL PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC10004738DE

General Provider Information

NPI Number : 1033190145
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST STATE MEDICAL PA
Provider Business Mailing Address
First Line : 3521 SILVERSIDE RD
Second Line : QUILLEN BUILDING SUITE 2D1
City : WILMINGTON
State : DE
Zip : 19810-4900
Country : US
Telephone Number : 302-479-0555
Fax Number : 302-479-5006
Provider Business Practice Location Address
First Line : 3521 SILVERSIDE RD
Second Line : QUILLEN BUILDING SUITE 2D1
City : WILMINGTON
State : DE
Zip : 19810-4900
Country : US
Telephone Number : 302-479-0555
Fax Number : 302-479-5006
Authorized Official
Title or Position : CEO/PRESIDENT
Name : DR. HUGH BONNER III
Credential : M.D.
Telephone Number : 302-479-0555
Provider Enumeration Date : 11/07/2005
Last Update Date : 08/22/2020

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Directions to “FIRST STATE MEDICAL PA ” Practice Location

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