=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841589678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT S MAHLER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2011
-----------------------------------------------------
Last Update Date | 04/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 WASHINGTON ST SUITE 304
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-8256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-1500
-----------------------------------------------------
Fax | 954-961-7942
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 WASHINGTON ST SUITE 304
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-8256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-961-1500
-----------------------------------------------------
Fax | 954-961-7942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT SETH MAHLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-961-1500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME98036
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------