Healthcare Provider Details

I. General information

NPI: 1689880999
Provider Name (Legal Business Name): FAUZIA S MAHR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAUZIA IQBAL M.D.

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W GOVERNOR RD SUITE 200
HERSHEY PA
17033-2307
US

IV. Provider business mailing address

PO BOX 858 CA410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-7235
  • Fax: 717-531-0067
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD431155
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD431155
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD431155
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD431155
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE
# 2
Identifier1022723250001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: