Provider Demographics
NPI:1720016538
Name:HORN, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:HORN
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:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-0552
Mailing Address - Country:US
Mailing Address - Phone:215-672-5260
Mailing Address - Fax:215-672-5287
Practice Address - Street 1:331 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2033
Practice Address - Country:US
Practice Address - Phone:215-672-5260
Practice Address - Fax:215-672-5287
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029516E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000197635OtherHIGHMARK BLUE SHIELD
PA0046682000OtherINDEPENDENCE BLUE CROSS
C33320Medicare UPIN
PA0046682000OtherINDEPENDENCE BLUE CROSS
PA517407Medicare PIN