Healthcare Provider Details

I. General information

NPI: 1093886897
Provider Name (Legal Business Name): SMA INTERNAL MEDICINE & ENDOCRINOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 DEAK DR
SMYRNA DE
19977-1268
US

IV. Provider business mailing address

38 DEAK DR
SMYRNA DE
19977-1268
US

V. Phone/Fax

Practice location:
  • Phone: 302-653-1669
  • Fax:
Mailing address:
  • Phone: 302-653-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0005633
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC1-0005633
License Number StateDE

VIII. Authorized Official

Name: BLANCA N OCAMPO-LIM
Title or Position: PHYSICIAN
Credential: M D
Phone: 302-653-1669