Healthcare Provider Details

I. General information

NPI: 1497622575
Provider Name (Legal Business Name): SWVA PREMIER PEDIATRICS AND INTERNAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 PARK AVE NW
NORTON VA
24273-1613
US

IV. Provider business mailing address

PO BOX 126
NORTON VA
24273-0126
US

V. Phone/Fax

Practice location:
  • Phone: 276-220-8861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL P. DEEL
Title or Position: OWNER
Credential:
Phone: 276-220-8861