Healthcare Provider Details

I. General information

NPI: 1811133341
Provider Name (Legal Business Name): PREMIER PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE SUITE 213
NEWARK DE
19702-4773
US

IV. Provider business mailing address

2600 GLASGOW AVE SUITE 213
NEWARK DE
19702-4773
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-4440
  • Fax: 302-836-4466
Mailing address:
  • Phone: 302-836-4440
  • Fax: 302-836-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY J SMITH
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 302-836-4440