Provider Demographics
NPI:1689193252
Name:HORIZON PEDIATRICS INC
Entity Type:Organization
Organization Name:HORIZON PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:UNDINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-236-9540
Mailing Address - Street 1:2415 MUSGROVE RD STE 308
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5223
Mailing Address - Country:US
Mailing Address - Phone:301-236-9540
Mailing Address - Fax:301-236-9578
Practice Address - Street 1:2415 MUSGROVE RD STE 308
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5223
Practice Address - Country:US
Practice Address - Phone:301-236-9540
Practice Address - Fax:301-236-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064412261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4108507P0001Medicaid