Provider Demographics
NPI:1649240193
Name:HORNEY, WAYNE D (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:HORNEY
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 1:221 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-5717
Mailing Address - Country:US
Mailing Address - Phone:276-228-6970
Mailing Address - Fax:
Practice Address - Street 1:911 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-4183
Practice Address - Country:US
Practice Address - Phone:540-745-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-030867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005615402Medicaid
VA1649240193Medicaid
VA015456C86Medicare PIN
VA080005161Medicare PIN
VA1649240193Medicaid
B06644Medicare UPIN