Provider Demographics
NPI:1851614317
Name:HORIZON INFECTIOUS DISEASES ASSOCIATES LLC
Entity Type:Organization
Organization Name:HORIZON INFECTIOUS DISEASES ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEDION
Authorized Official - Middle Name:
Authorized Official - Last Name:ATNAFU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-636-6319
Mailing Address - Street 1:12701 TRUTHS PROMISE CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5600
Mailing Address - Country:US
Mailing Address - Phone:443-636-6319
Mailing Address - Fax:
Practice Address - Street 1:300 ARMORY PL
Practice Address - Street 2:SUITE 3 I
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4603
Practice Address - Country:US
Practice Address - Phone:443-636-6319
Practice Address - Fax:877-648-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062148207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408456000Medicaid
MD408456000Medicaid