Basic Information
| Provider Information | |||||||||
| NPI: | 1326442542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHAUTMR | ||||||||
| FirstName: | PENDEN | ||||||||
| MiddleName: | PATTI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 CHESTERBROOK BLVD | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193123805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105767636 | ||||||||
| FaxNumber: | 3346133685 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 SOUTH STREET | ||||||||
| Address2: | TUTTLEMAN BUILDING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191467411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158936200 | ||||||||
| FaxNumber: | 2158936215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 12/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD459539 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.