Provider Demographics
NPI:1093759144
Name:MAURER, PHILIP MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:MITCHELL
Last Name:MAURER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-1672
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1672
Mailing Address - Country:US
Mailing Address - Phone:215-807-8330
Mailing Address - Fax:215-807-8242
Practice Address - Street 1:380 OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8304
Practice Address - Country:US
Practice Address - Phone:215-409-9300
Practice Address - Fax:215-409-9368
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD03208EL207LP2900X
NJ25MA06339100207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0033075000OtherI.B.C.
PA2069584OtherAETNA
PA0033075000OtherI.B.C.
PA2069584OtherAETNA
PA487223Medicare ID - Type Unspecified