Provider Demographics
NPI:1770825937
Name:HORN, DELIA MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DELIA
Middle Name:MARIE
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DELIA
Other - Middle Name:MARIE
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71 ALLEN POND
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-772-4414
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:1 GENERAL WING RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4681
Practice Address - Country:US
Practice Address - Phone:802-773-9131
Practice Address - Fax:802-773-1551
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013435208000000X
390200000X
VT042-00134352080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTY400332108Medicare PIN