Healthcare Provider Details

I. General information

NPI: 1871386839
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEUROLOGY WAY
MILFORD DE
19963-5368
US

IV. Provider business mailing address

620 STANTON CHRISTIANA RD STE 101
NEWARK DE
19713-2134
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-5109
  • Fax: 877-575-3337
Mailing address:
  • Phone: 302-449-9314
  • Fax: 877-575-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LYRON ANDRE DEPUTY
Title or Position: OWNER
Credential:
Phone: 302-652-5109