Provider Demographics
NPI:1902950603
Name:FIRST STATE ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:FIRST STATE ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THIRUMALESHAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-225-2380
Mailing Address - Street 1:PO BOX 6385
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-0985
Mailing Address - Country:US
Mailing Address - Phone:302-225-2380
Mailing Address - Fax:302-225-2388
Practice Address - Street 1:4923 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2081
Practice Address - Country:US
Practice Address - Phone:302-225-2380
Practice Address - Fax:302-225-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7567859OtherAETNA
2818802000OtherAMERIHEALTH/KEYSTONE
DG28116OtherRAILROAD MEDICARE
7567859OtherAETNA