Provider Demographics
NPI:1184647190
Name:HORVATH, EDWARD MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:HORVATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4070
Mailing Address - Country:US
Mailing Address - Phone:301-953-3800
Mailing Address - Fax:301-604-2657
Practice Address - Street 1:632 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4070
Practice Address - Country:US
Practice Address - Phone:301-953-3800
Practice Address - Fax:301-604-2657
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1207213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2060388004Medicaid
U52408Medicare UPIN
MD2060388004Medicaid