Provider Demographics
NPI:1366449365
Name:HORIZON SURGICAL GROUP, PA
Entity Type:Organization
Organization Name:HORIZON SURGICAL GROUP, PA
Other - Org Name:HORIZON VASCULAR SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-330-1000
Mailing Address - Street 1:20410 OBSERVATION DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6419
Mailing Address - Country:US
Mailing Address - Phone:301-762-0277
Mailing Address - Fax:301-330-9108
Practice Address - Street 1:20410 OBSERVATION DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6419
Practice Address - Country:US
Practice Address - Phone:301-762-0277
Practice Address - Fax:301-330-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD915011100Medicaid
DC153849Medicare PIN
MD328PMedicare PIN