Provider Demographics
NPI:1376647537
Name:HOROWITZ, IRVIN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:IRVIN
Middle Name:ROBERT
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:I
Other - Middle Name:ROBERT
Other - Last Name:HOROWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11505 LE HAVRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3119
Mailing Address - Country:US
Mailing Address - Phone:301-299-6610
Mailing Address - Fax:301-299-6478
Practice Address - Street 1:121 CONGRESSIONAL LANE
Practice Address - Street 2:SUITE 416
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-468-9090
Practice Address - Fax:301-468-1420
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015098207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD174315Medicare ID - Type Unspecified
D09469Medicare UPIN