Provider Demographics
NPI:1174214696
Name:PREMIER MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPUTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-449-7484
Mailing Address - Street 1:620 STANTON CHRISTIANA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2134
Mailing Address - Country:US
Mailing Address - Phone:302-449-7484
Mailing Address - Fax:
Practice Address - Street 1:701 FOULK RD STE 1G
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3733
Practice Address - Country:US
Practice Address - Phone:302-449-7484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty