First State Infectious Disease Specialists LLC
Organization Active NPI Specialist · Wilmington, DE
NPI 1124214044 · NPPES record last updated Sep 25, 2007
Key facts
- NPI
- 1124214044
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- FIRST STATE INFECTIOUS DISEASE SPECIALISTS LLC
- Practice address
- 3301 Lancaster Pike
Suite 9
Wilmington, DE 19805-1436 - Phone
- (302) 661-2303
- Fax
- (302) 661-2324
- NPI assigned
- Sep 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kirsten Andrea Hauer, M. D.
- Title
- Physician
- Phone
- (302) 661-2303
Practitioners 2
-
Susheer Gandotra, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080410000284 | DE | Part B Supplier - Clinic/Group Practice | 0547347882 |
Receives reassigned benefits from 1 practitioner Practice locations: Wilmington, DE |
National Provider Directory
Locations
3301 Lancaster Pike
Ste 1B
Wilmington, DE 19805
Phone (302) 661-2303
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | TP0003432 | DE | |
| Specialist |
174400000X | DE | Yes |
Addresses
Primary practice location
3301 Lancaster Pike
Suite 9
Wilmington, DE 19805-1436
Mailing address
3301 Lancaster Pike
Suite 9
Wilmington, DE 19805-1436
Phone (302) 661-2303
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000398601 | Medicaid | DE |
Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.