Provider Demographics
NPI:1073771390
Name:HORN, DOUGLAS (HIS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HORN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 RITCHIE HWY STE 316
Mailing Address - Street 2:EMPIRE TOWERS
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3109
Mailing Address - Country:US
Mailing Address - Phone:877-255-3277
Mailing Address - Fax:866-236-7933
Practice Address - Street 1:7310 RITCHIE HWY STE 316
Practice Address - Street 2:EMPIRE TOWERS
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3109
Practice Address - Country:US
Practice Address - Phone:877-255-3277
Practice Address - Fax:866-236-7933
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02474237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist