Provider Demographics
NPI:1558345991
Name:DAUB, HORATIO G (MD)
Entity Type:Individual
Prefix:DR
First Name:HORATIO
Middle Name:G
Last Name:DAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3425
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:1636 ROUTE 38 & EAYRESTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2939
Practice Address - Country:US
Practice Address - Phone:609-914-8440
Practice Address - Fax:609-914-8441
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04087000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2329301Medicaid
NJC57317Medicare UPIN
NJ2329301Medicaid
NJ106518R63Medicare PIN