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
State | License ID | Taxonomies |
---|---|---|
PA | MD070295L | 207W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0017861420001 | Medicaid | |
CF3515 | Other | RAILROAD MEDICARE GROUP # | |
180038595 | Other | RR MEDICARE INDIVIDUAL | |
180038595 | Other | RR MEDICARE INDIVIDUAL | |
614146 | Medicare ID - Type Unspecified | GROUP # |