Provider Demographics
NPI:1922014117
Name:HORODNIC, ROBERT P (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:HORODNIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N MEADOWS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8369
Mailing Address - Country:US
Mailing Address - Phone:724-934-5040
Mailing Address - Fax:
Practice Address - Street 1:103 N MEADOWS DR
Practice Address - Street 2:SUITE 221
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8369
Practice Address - Country:US
Practice Address - Phone:724-934-5040
Practice Address - Fax:724-934-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008374L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015470360001Medicaid
PAG10283Medicare UPIN
PA787180Medicare ID - Type Unspecified