Provider Demographics
NPI:1417678228
Name:PREMIER MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-449-9314
Mailing Address - Street 1:620 STANTON CHRISTIANA RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2133
Mailing Address - Country:US
Mailing Address - Phone:302-449-7484
Mailing Address - Fax:302-327-4203
Practice Address - Street 1:700 W LEA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2546
Practice Address - Country:US
Practice Address - Phone:302-764-2072
Practice Address - Fax:302-764-9347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-09
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty