Provider Demographics
NPI:1356303952
Name:MAUTHE, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:MAUTHE
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 1:4676 ROUTE 309
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8200
Mailing Address - Country:US
Mailing Address - Phone:610-791-7690
Mailing Address - Fax:610-791-7693
Practice Address - Street 1:4676 ROUTE 309
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8200
Practice Address - Country:US
Practice Address - Phone:610-791-7690
Practice Address - Fax:610-791-7693
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA036783E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE52820Medicare UPIN
PA460538UR3Medicare ID - Type Unspecified