Healthcare Provider Details

I. General information

NPI: 1417918897
Provider Name (Legal Business Name): MARITA MAPUA FALLORINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CATHERINE ST
NEW CASTLE DE
19720-3001
US

IV. Provider business mailing address

1 CATHERINE ST
NEW CASTLE DE
19720-3001
US

V. Phone/Fax

Practice location:
  • Phone: 302-322-6847
  • Fax: 302-322-6909
Mailing address:
  • Phone: 302-322-6847
  • Fax: 302-322-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10000755
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10000755
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: