Provider Demographics
NPI:1003802133
Name:HORWITZ, SCOTT M (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 WASHINGTON ST
Mailing Address - Street 2:SUITE 304A
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-254-1344
Mailing Address - Fax:617-783-4803
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE304A
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-254-1344
Practice Address - Fax:617-783-4803
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001787213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0361666Medicaid
T58780Medicare UPIN
MA0361666Medicaid
MAY70823Medicare ID - Type Unspecified