Provider Demographics
NPI:1861282428
Name:PREMIUM MEDICAL LLC
Entity type:Organization
Organization Name:PREMIUM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUDOZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCHAA-UCHEFUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-722-0793
Mailing Address - Street 1:85 MAIN ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1225
Mailing Address - Country:US
Mailing Address - Phone:443-722-0793
Mailing Address - Fax:
Practice Address - Street 1:85 MAIN ST STE 4A
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1225
Practice Address - Country:US
Practice Address - Phone:443-722-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care