Provider Demographics
NPI:1720059298
Name:MAUER, MARK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:MAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:123 CONHOCTON ST STE 101
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2959
Practice Address - Country:US
Practice Address - Phone:607-438-1200
Practice Address - Fax:607-438-1221
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039478E207Q00000X
NY172789-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01200595Medicaid
PA0014535010002Medicaid
NY080173404OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
E52487Medicare UPIN
NY01200595Medicaid