Healthcare Provider Details

I. General information

NPI: 1174214696
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FOULK RD STE 1G
WILMINGTON DE
19803-3733
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:
Mailing address:
  • Phone: 302-449-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. LYRON DEPUTY
Title or Position: CEO
Credential: NP
Phone: 302-449-9314