Provider Demographics
NPI:1881685329
Name:VANHORN, STEWART D (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:D
Last Name:VANHORN
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 1:50 WATERFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2518
Mailing Address - Country:US
Mailing Address - Phone:814-849-8344
Mailing Address - Fax:814-849-7130
Practice Address - Street 1:50 WATERFORD PIKE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2518
Practice Address - Country:US
Practice Address - Phone:814-849-8344
Practice Address - Fax:814-849-7130
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070295L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017861420001Medicaid
CF3515OtherRAILROAD MEDICARE GROUP #
180038595OtherRR MEDICARE INDIVIDUAL
180038595OtherRR MEDICARE INDIVIDUAL
614146Medicare ID - Type UnspecifiedGROUP #