Provider Demographics
NPI:1417918897
Name:FALLORINA, MARITA MAPUA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITA
Middle Name:MAPUA
Last Name:FALLORINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3001
Mailing Address - Country:US
Mailing Address - Phone:302-322-6847
Mailing Address - Fax:302-322-6909
Practice Address - Street 1:1 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3001
Practice Address - Country:US
Practice Address - Phone:302-322-6847
Practice Address - Fax:302-322-6909
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000755208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE48401Medicaid
DE123610Medicare ID - Type Unspecified
DEC48727Medicare UPIN