1548691710 NPI number — FIRST STATE ORTHOPAEDICS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548691710 NPI number — FIRST STATE ORTHOPAEDICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STATE ORTHOPAEDICS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548691710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 EXECUTIVE DR
Provider Second Line Business Mailing Address:
STE 11
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-731-2888
Provider Business Mailing Address Fax Number:
302-731-7049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4051 OGLETOWN RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-731-2888
Provider Business Practice Location Address Fax Number:
302-731-7049
Provider Enumeration Date:
12/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BLAEUER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
302-731-2888

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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