Provider Demographics
NPI:1194894204
Name:SMITH, GISELE (MD)
Entity type:Individual
Prefix:DR
First Name:GISELE
Middle Name:
Last Name:SMITH
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 1:1510 CHRISTIANA MDWS
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2829
Mailing Address - Country:US
Mailing Address - Phone:267-253-5606
Mailing Address - Fax:
Practice Address - Street 1:575 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4606
Practice Address - Country:US
Practice Address - Phone:302-328-3330
Practice Address - Fax:302-328-9336
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100073772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE005148N6DMedicare ID - Type UnspecifiedMEDICARE B