Healthcare Provider Details

I. General information

NPI: 1629328547
Provider Name (Legal Business Name): NEHA MARISSA SOARES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 PORTMARNOCK CT
DOVER DE
19904
US

IV. Provider business mailing address

212 PORTMARNOCK CT
DOVER DE
19904-9430
US

V. Phone/Fax

Practice location:
  • Phone: 248-707-4931
  • Fax:
Mailing address:
  • Phone: 248-707-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC1-0011719
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR73433
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: