Provider Demographics
NPI:1588752661
Name:MAYNE, DAVID R (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MAYNE
Suffix:
Gender:
Credentials:DO
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Mailing Address - Street 1:100 N ACADEMY AVE # 4903
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-703-7351
Practice Address - Fax:570-703-7801
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017558370001Medicaid
PA105902YGDBMedicare PIN
PA1017558370001Medicaid