Provider Demographics
NPI:1386945442
Name:FIRST STATE ORTHOPAEDICS PA
Entity type:Organization
Organization Name:FIRST STATE ORTHOPAEDICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-451-6913
Mailing Address - Street 1:211 EXECUTIVE DR STE 11
Mailing Address - Street 2:
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 1:26744 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4667
Practice Address - Country:US
Practice Address - Phone:302-644-3311
Practice Address - Fax:302-644-3300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST STATE ORTHOPAEDICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207LP2900X, 208600000X, 2086S0105X, 213E00000X
DE207X00000X, 208100000X, 213ES0103X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0848032000OtherAMERIHEALTH
510370286OtherUNION LABOR LIFE INSURANCE COMPANY
510370286OtherONE NET PPO, MAMSI, OPTIMUM CHOICE, M.D. IPA
510370286OtherCORVEL / CORCARE
510370286OtherHEALTH NET TRICARE / CHAMPUS
1030265OtherAETNA US HEALTHCARE
510370286OtherUNITED HEALTH CARE
DE0000633502Medicaid
510343207OtherBLUE CROSS BLUE SHIELD OF DELAWARE
510370286OtherEASTERN SUSSEX PHYSICIANS ORGANIZATION
510370286OtherRAILROAD MEDICARE
510370286OtherPERDUE FARMS, INC.
510370286OtherCIGNA
510370286OtherCOVENTRY HEALTHCARE OF DELAWARE
510370286OtherDEVON HEALTH SERVICES
510370286OtherGREAT WEST HEALTHCARE
204885OtherUNISON HEALTH PLAN
510343207OtherBLUE CROSS BLUE SHIELD OF DELAWARE
=========OtherCOVENTRY HEALTHCARE OF DELAWARE