Healthcare Provider Details

I. General information

NPI: 1154836500
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 302-449-7484
  • Fax: 302-327-4203
Mailing address:
  • Phone: 302-449-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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