Provider Demographics
NPI:1922000611
Name:HORN, JAMES FLETCHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FLETCHER
Last Name:HORN
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 1:62 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1718
Mailing Address - Country:US
Mailing Address - Phone:518-434-2244
Mailing Address - Fax:518-434-4659
Practice Address - Street 1:62 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1718
Practice Address - Country:US
Practice Address - Phone:518-434-2244
Practice Address - Fax:518-434-4659
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144762-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00916165Medicaid
NY00916165Medicaid
33788GMedicare ID - Type Unspecified