Healthcare Provider Details

I. General information

NPI: 1215745724
Provider Name (Legal Business Name): PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E UWCHLAN AVE STE 200
EXTON PA
19341-1293
US

IV. Provider business mailing address

PO BOX 34990
BELFAST ME
04915-0627
US

V. Phone/Fax

Practice location:
  • Phone: 484-713-4172
  • Fax:
Mailing address:
  • Phone: 610-359-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY MALUMED
Title or Position: PRESIDENT
Credential:
Phone: 610-521-9996