| Premiere Physicians P.a. | |
|
314 E Main St Suite 103 Newark DE 19711-7128 | |
| (302) 366-0550 | |
| (302) 366-8905 |
| Full Name | Premiere Physicians P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 314 E Main St, Newark, Delaware |
| Authorized Official Name and Position | Ingrid Agard (PRACTICE MANAGER) |
| Authorized Official Contact | 3023660550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premiere Physicians P.a. 314 E Main St Suite 103 Newark DE 19711-7128 Ph: (302) 366-0550 | Premiere Physicians P.a. 314 E Main St Suite 103 Newark DE 19711-7128 Ph: (302) 366-0550 |
| NPI Number | 1760580336 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 10/26/2012 |
| Medicare PECOS PAC ID | 7416845383 |
|---|---|
| Medicare Enrollment ID | O20040310001048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760580336 | NPI | - | NPPES |
| 1000024589 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Reynold S Agard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902811730 PECOS PAC ID: 9032007919 Enrollment ID: I20040311000509 |
| Provider Name | Judy M Lim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083667208 PECOS PAC ID: 1557310398 Enrollment ID: I20050119000295 |
| Provider Name | Dawn M Poletaev |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467005827 PECOS PAC ID: 3072924315 Enrollment ID: I20201118000687 |
| Provider Name | Nicole R Mccarry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750048690 PECOS PAC ID: 1052798493 Enrollment ID: I20220524002177 |
| Provider Name | Sam W Kidane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497412399 PECOS PAC ID: 1254719289 Enrollment ID: I20220603001667 |
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