Organization
ENT R NET, P A
Active
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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