=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013076991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAINBOW PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2006
-----------------------------------------------------
Last Update Date | 12/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21141 STERLING AVE UNIT 1
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19947-5571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-856-6967
-----------------------------------------------------
Fax | 302-855-0744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21141 STERLING AVE UNIT 1
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19947-5571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-856-6967
-----------------------------------------------------
Fax | 302-855-0744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | VIBHA SANWAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-381-5528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | C10006252
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | C10005413
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------