NPIMap

Organization Active NPI

Premier Dermatology

  • Medical Physician Assistant
  • Newark, DE
National Provider Identifier
1104270834
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C5-0001054 Issued in DE
Legal business name
PREMIER DERMATOLOGY
Practice address
537 Stanton Christiana Rd
Suites 107,111,207 & 209
Newark, DE 19713-2146
Phone
(302) 633-7550
NPI assigned
Apr 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marypat Kwoka, MSM
Title
Practice Administrator
Phone
(302) 633-7550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X C5-0001054 DE Primary

Addresses

Primary practice location

537 Stanton Christiana Rd
Suites 107,111,207 & 209
Newark, DE 19713-2146

Mailing address

537 Stanton Christiana Rd
Suites 107,111,207 & 209
Newark, DE 19713-2146
Phone (302) 633-7550

Other identifiers 1

IdentifierTypeStateIssuer
C5-0001054OtherDEDIVISION OF PROFESSIONAL REGULATION LICENSE

Other names 1

  • Panzer Dermatology Doing business as

National Provider Directory

National Provider Directory

Locations

537 Stanton Christiana Rd
Ste 209
Newark, DE 19713
Phone (302) 225-0175

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1104270834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 STANTON CHRISTIANA RD",
            "address_2": "SUITES 107,111,207 & 209",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132146",
            "telephone_number": "302-633-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 STANTON CHRISTIANA RD",
            "address_2": "SUITES 107,111,207 & 209",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132146",
            "telephone_number": "302-633-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "KWOKA",
        "authorized_official_first_name": "MARYPAT",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "302-633-7550",
        "authorized_official_credential": "MSM"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "DE",
            "license": "C5-0001054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIVISION OF PROFESSIONAL REGULATION LICENSE",
            "identifier": "C5-0001054",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panzer Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.