Provider Demographics
NPI:1043391709
Name:SMA PEDIATRICS, LLC
Entity Type:Organization
Organization Name:SMA PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MA CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-653-6174
Mailing Address - Street 1:38 DEAK DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977
Mailing Address - Country:US
Mailing Address - Phone:302-653-6174
Mailing Address - Fax:302-653-6029
Practice Address - Street 1:38 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-653-6174
Practice Address - Fax:302-653-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000185001Medicaid
467827OtherAETNA HMO 19
1000038432OtherDPCI
8141834OtherALLIANCE
1000038432OtherMEDICAID DE
2675733000OtherAMERIHEALTH HMO
2675733000OtherAMERIHEALTH PPO
5304OtherAETNA PPO
8141834OtherMAMSI
8141834OtherMAMSI
DE0000185001Medicaid
1000038432OtherDPCI
467827OtherAETNA HMO 19
DE0000185001Medicaid