Provider Demographics
NPI:1497077937
Name:MAUTONE, JOHN THOMAS (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:MAUTONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ROUTE 44
Mailing Address - Street 2:
Mailing Address - City:MILLERTON
Mailing Address - State:NY
Mailing Address - Zip Code:12546-5237
Mailing Address - Country:US
Mailing Address - Phone:518-789-3444
Mailing Address - Fax:
Practice Address - Street 1:108 ROUTE 44
Practice Address - Street 2:
Practice Address - City:MILLERTON
Practice Address - State:NY
Practice Address - Zip Code:12546-5237
Practice Address - Country:US
Practice Address - Phone:518-789-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist