Provider Demographics
NPI:1932241452
Name:ROBERT W. MAUTHE, M.D. P.C.
Entity Type:Organization
Organization Name:ROBERT W. MAUTHE, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOESKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-791-7690
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA036783E225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty