Provider Demographics
NPI:1023011707
Name:HORNE, DALE S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:S
Last Name:HORNE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 BELLEVUE AVE
Mailing Address - Street 2:STE 4100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-3286
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5297
Practice Address - Street 1:3113 BELLEVUE AVE STE 4100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-3286
Practice Address - Country:US
Practice Address - Phone:513-475-8990
Practice Address - Fax:513-475-8577
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087428207T00000X, 207T00000X
IN01046932A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2643438Medicaid
KY0760401Medicaid
IN200147410Medicaid
OHHO4180741Medicare PIN
OH2643438Medicaid