Provider Demographics
NPI:1588620058
Name:VANHORN, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:VANHORN
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 1:295 OLMSTED BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9131
Mailing Address - Country:US
Mailing Address - Phone:919-239-4711
Mailing Address - Fax:888-899-3302
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8903
Practice Address - Country:US
Practice Address - Phone:843-347-5060
Practice Address - Fax:843-347-3959
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-008862084P0805X, 2084P0800X
NY2287992084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY492BA1OtherBLUE CROSS
NY050103000028OtherFIDELIS
SCAA24050281OtherMEDICARE PALMETTO GBA
NY10091505OtherCDPHP
NY11398516OtherCAQH
NY4141636OtherMVP
NY000408404001OtherBLUE SHIELD
E33479Medicare UPIN
NY10091505OtherCDPHP
SCAA24050281OtherMEDICARE PALMETTO GBA