ENT R Net PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

ENT R NET PA

Practice address

4190 City Line Avenue
Suite 526
Philadelphia, PA 19131-1635

Phone

(215) 879-0060

Fax

(215) 879-0063

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theodore Paul Mauer, DO

Title

President Owner

Phone

(215) 879-0060

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811007487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 CITY LINE AVENUE",
            "address_2": "SUITE 526",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311635",
            "telephone_number": "215-879-0060",
            "fax_number": "215-879-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 CITY LINE AVENUE",
            "address_2": "SUITE 526",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311635",
            "telephone_number": "215-879-0060",
            "fax_number": "215-879-0063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT R NET PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAUER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "215-879-0060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HEALTH PLA",
            "identifier": "30723A",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007250440006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Otolaryngology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.