Provider Demographics
NPI:1114984853
Name:HORNER, DAMIAN T (DO)
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:T
Last Name:HORNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLUMBER ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1202
Mailing Address - Country:US
Mailing Address - Phone:814-723-2779
Mailing Address - Fax:814-723-1518
Practice Address - Street 1:10 PLUMBER ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1202
Practice Address - Country:US
Practice Address - Phone:814-723-7229
Practice Address - Fax:814-723-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05012479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101118527Medicaid
PA1637215OtherBS
PA164588OtherUNISON
26908201OtherUNIVERA
P00189629OtherPALMETTO
PA1637215OtherBS
PA083497D6JMedicare ID - Type Unspecified