Provider Demographics
NPI:1548691710
Name:FIRST STATE ORTHOPAEDICS PA
Entity type:Organization
Organization Name:FIRST STATE ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAEUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-731-2888
Mailing Address - Street 1:211 EXECUTIVE DR
Mailing Address - Street 2:STE 11
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3358
Mailing Address - Country:US
Mailing Address - Phone:302-731-2888
Mailing Address - Fax:302-731-7049
Practice Address - Street 1:4051 OGLETOWN STANTON RD
Practice Address - Street 2:STE 103
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-731-2888
Practice Address - Fax:302-731-7049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STATE ORTHOPAEDICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-12
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty