=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902889611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDERICK ROBERT MAUE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2005
-----------------------------------------------------
Last Update Date | 09/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1083 BLOOM RD STE 1
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17821-6789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-275-6080
-----------------------------------------------------
Fax | 570-275-6089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 WASHINGTON AVE.
-----------------------------------------------------
City | SUNBURY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-571-2221
-----------------------------------------------------
Fax | 570-286-1703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD025476E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------