Provider Demographics
NPI:1437145356
Name:HORNEFFER, PETER JULIAN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JULIAN
Last Name:HORNEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6491
Mailing Address - Country:US
Mailing Address - Phone:240-964-8724
Mailing Address - Fax:240-964-8735
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:SUITE 470
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:240-964-8724
Practice Address - Fax:240-964-8735
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030446208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07135110Medicaid
MD137146ZB9FMedicare PIN
E64661Medicare UPIN