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Organization

ENT R NET, P A

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THEODORE MAUER D.O. (OWNER)
(215) 879-0060
Entity
Organization

Contact information

Practice address
4190 CITY AVE, SUITE 526, PHILADELPHIA, PA 19131-1626
(215) 879-0060
(215) 879-0063
Mailing address
4190 CITY AVE, SUITE 526, PHILADELPHIA, PA 19131-1626
(215) 879-0060
(215) 879-0063

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
OS001941L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0170250000
INDEPENDENCE BLUE CROSS
PA
01
183919
HIGHMARK BLUE SHIELD
PA
01
30723
KEYSTONE MERCY
PA
Enumeration date
06/18/2006
Last updated
08/22/2020
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