MEDICARE: SWVA PREMIER PEDIATRICS AND INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1497622575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWVA PREMIER PEDIATRICS AND INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273-0126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 PARK AVE NW
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273-1613
Country	:	US
Telephone Number	:	276-220-8861
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMUEL P. DEEL
Credential	:
Telephone Number	:	276-220-8861

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	03/19/2026

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Directions to “SWVA PREMIER PEDIATRICS AND INTERNAL MEDICINE ” Practice Location

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