Healthcare Provider Details

I. General information

NPI: 1225484116
Provider Name (Legal Business Name): LYDIA ROSE MAURER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-3309
US

IV. Provider business mailing address

51 N 39TH ST 1 MOB, STE 120
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 978-808-3232
  • Fax:
Mailing address:
  • Phone: 978-808-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number277964
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number277964
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: