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General NPI Number Information
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NPI Number | 1902216443
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Entity Type | Individual
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Provider Name | LISA ELPHICK SMALE DO
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Gender | Female
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 640 S STATE ST
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City | DOVER
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State | DE
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Zip | 19901-3530
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Country | US
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Telephone | 302-674-4700
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Fax | 302-735-3845
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Provider Business Mailing Address
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Address Line | 104 MALLARD DR
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City | LEWES
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State | DE
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Zip | 19958-1606
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Country | US
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Telephone | 484-300-6043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C2-0012047
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS20416
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License Number State | FL
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