Healthcare Provider Details

I. General information

NPI: 1710948443
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 BOSTON POST RD
OLD SAYBROOK CT
06475-2143
US

IV. Provider business mailing address

929 BOSTON POST RD
OLD SAYBROOK CT
06475-2143
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-1115
  • Fax:
Mailing address:
  • Phone: 860-388-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number26345
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26345
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042317
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier50PREMIERCT01
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBLUE CROSS

VIII. Authorized Official

Name: DR. STEVEN ANTHONY GAUDIO
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 860-388-1115