Provider Demographics
NPI:1679827745
Name:HORSLEY, HEIDE B (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDE
Middle Name:B
Last Name:HORSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 HOLLOW VIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672
Mailing Address - Country:US
Mailing Address - Phone:802-253-2990
Mailing Address - Fax:802-253-3018
Practice Address - Street 1:746 HOLLOW VIEW ROAD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672
Practice Address - Country:US
Practice Address - Phone:802-253-2990
Practice Address - Fax:802-253-3018
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics