Organization
ENT R NET PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE PAUL MAUER DO (PRESIDENT OWNER)
(215) 879-0060
Entity
Organization
Contact information
Practice address
4190 CITY LINE AVENUE, SUITE 526, PHILADELPHIA, PA 19131-1635
(215) 879-0060
(215) 879-0063
Mailing address
4190 CITY LINE AVENUE, SUITE 526, PHILADELPHIA, PA 19131-1635
(215) 879-0060
(215) 879-0063
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007250440006
—
PA
01
—
30723A
KEYSTONE MERCY HEALTH PLA
PA
Enumeration date
08/30/2006
Last updated
08/22/2020
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