Healthcare Provider Details

I. General information

NPI: 1194894204
Provider Name (Legal Business Name): GISELE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S DUPONT HWY
NEW CASTLE DE
19720-4606
US

IV. Provider business mailing address

1510 CHRISTIANA MDWS
BEAR DE
19701-2829
US

V. Phone/Fax

Practice location:
  • Phone: 302-328-3330
  • Fax: 302-328-9336
Mailing address:
  • Phone: 267-253-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC10007377
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: