Provider Demographics
NPI:1689880999
Name:MAHR, FAUZIA S (MD)
Entity Type:Individual
Prefix:
First Name:FAUZIA
Middle Name:S
Last Name:MAHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAUZIA
Other - Middle Name:
Other - Last Name:IQBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:905 W GOVERNOR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2307
Practice Address - Country:US
Practice Address - Phone:717-531-7235
Practice Address - Fax:717-531-0067
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4311552080A0000X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD431155OtherMEDICAL LICENSE
PA1022723250001Medicaid
PA139920Medicare PIN