# FIRST STATE MEDICAL PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033190145
- **Authorized official:** DR. HUGH BONNER III M.D. (CEO/PRESIDENT)
- **Authorized official phone:** (302) 479-0555

## Contact information

- **Practice address:** 3521 SILVERSIDE RD, QUILLEN BUILDING SUITE 2D1, WILMINGTON, DE 19810-4900
- **Practice address phone:** (302) 479-0555
- **Practice address fax:** (302) 479-5006
- **Mailing address:** 3521 SILVERSIDE RD, QUILLEN BUILDING SUITE 2D1, WILMINGTON, DE 19810-4900
- **Mailing address phone:** (302) 479-0555
- **Mailing address fax:** (302) 479-5006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | C10004738 | DE | Yes |

## Other

- **Enumeration date:** 11/07/2005
- **Last updated:** 08/22/2020