Provider Demographics
NPI:1760484018
Name:HORAH, CHRISTINE EDITH KERSHNER (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EDITH KERSHNER
Last Name:HORAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SUBURBAN PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3564
Mailing Address - Country:US
Mailing Address - Phone:302-738-3770
Mailing Address - Fax:302-738-4749
Practice Address - Street 1:412 SUBURBAN PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-3564
Practice Address - Country:US
Practice Address - Phone:302-738-3770
Practice Address - Fax:302-738-4749
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005526207Q00000X
MDH0054380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510410752Medicaid
DEP00908838OtherMEDICARE RAILROAD PROVIDER PTAN
510410752OtherEMPLOYER IDENT. NUMBER
DE0001132004Medicaid
DEG97242Medicare UPIN
MD219M292FMedicare ID - Type UnspecifiedMARYLAND PROVIDER NUMBER
DEP00908838OtherMEDICARE RAILROAD PROVIDER PTAN