Healthcare Provider Details

I. General information

NPI: 1043391709
Provider Name (Legal Business Name): SMA PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 DEAK DR
SMYRNA DE
19977
US

IV. Provider business mailing address

38 DEAK DR
SMYRNA DE
19977
US

V. Phone/Fax

Practice location:
  • Phone: 302-653-6174
  • Fax: 302-653-6029
Mailing address:
  • Phone: 302-653-6174
  • Fax: 302-653-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MA CARIDAD ROSAL
Title or Position: PARTNER
Credential: MD
Phone: 302-653-6174