Provider Demographics
NPI:1902889611
Name:MAUE, FREDERICK ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROBERT
Last Name:MAUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801
Mailing Address - Country:US
Mailing Address - Phone:717-571-2221
Mailing Address - Fax:570-286-1703
Practice Address - Street 1:1083 BLOOM RD STE 1
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-6789
Practice Address - Country:US
Practice Address - Phone:570-275-6080
Practice Address - Fax:570-275-6089
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025476E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008518450004Medicaid
PAC30047Medicare UPIN
C30047Medicare UPIN
PA0008518450004Medicaid
PA102872GUIMedicare PIN