Provider Demographics
NPI:1497791032
Name:VAN HORN, LORI LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEIGH
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LEIGH
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 LAWRENCE LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2968
Mailing Address - Country:US
Mailing Address - Phone:540-373-4794
Mailing Address - Fax:540-710-6001
Practice Address - Street 1:10411 COURTHOUSE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1798
Practice Address - Country:US
Practice Address - Phone:540-710-6006
Practice Address - Fax:540-710-6001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77719Medicare UPIN