Provider Demographics
NPI:1619228491
Name:HORNER, WALTER HARRY (PHD, MD, ESQ)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:HARRY
Last Name:HORNER
Suffix:
Gender:M
Credentials:PHD, MD, ESQ
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:HARRY
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, MD, ESQ
Mailing Address - Street 1:1421 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2347
Mailing Address - Country:US
Mailing Address - Phone:304-599-2240
Mailing Address - Fax:866-375-5947
Practice Address - Street 1:1421 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2347
Practice Address - Country:US
Practice Address - Phone:304-599-2240
Practice Address - Fax:866-375-5947
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23225207R00000X
VA0101037164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine