Provider Demographics
NPI:1841255247
Name:SMA MEDICINE, LLC
Entity type:Organization
Organization Name:SMA MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUFINO
Authorized Official - Middle Name:VILLAR
Authorized Official - Last Name:ROSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-653-6174
Mailing Address - Street 1:198 RAVEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-4016
Mailing Address - Country:US
Mailing Address - Phone:302-678-2334
Mailing Address - Fax:
Practice Address - Street 1:38 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1268
Practice Address - Country:US
Practice Address - Phone:302-653-6174
Practice Address - Fax:302-653-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1 0005332207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDE5704OtherRAILROAD MEDICARE
DE0000945801Medicaid
DEDE5704OtherRAILROAD MEDICARE
DE0000945801Medicaid