MEDICARE: PREMIERE PERINATAL ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	ME43546	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386643187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERE PERINATAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:	919-425-0478

Provider Business Practice Location Address
First Line	:	2964 N STATE ROAD 7 STE 300
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5715
Country	:	US
Telephone Number	:	954-468-3080
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	877-328-1119

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/15/2022

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