Provider Demographics
NPI:1912062720
Name:MAYER, EUGENE M (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:MAYER
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 1:2000 GRANT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4378
Mailing Address - Country:US
Mailing Address - Phone:215-333-1776
Mailing Address - Fax:215-333-0653
Practice Address - Street 1:2000 GRANT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4378
Practice Address - Country:US
Practice Address - Phone:215-333-1776
Practice Address - Fax:215-333-0653
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014541E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006644770003Medicaid
D75973Medicare UPIN
103372FB6Medicare ID - Type Unspecified