Provider Demographics
NPI:1023094612
Name:HOROWITZ, MARTIN I (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:I
Last Name:HOROWITZ
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 1:147 MILK STREET
Mailing Address - Street 2:9TH FLOOR, HARVARD VANGUARD MEDICAL ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4862
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2500
Practice Address - Fax:781-221-2510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB10467002OtherCIGNA
MA12-04574OtherUNITED HEALTHCARE
MA0140759Medicaid
MA058201OtherTUFTS HEALTH CARE
MAC21027OtherBLUE CROSS
MA3547318OtherAETNA
MAPP130OtherHARVARD PILGRIM
MA0015118OtherNEIGHBORHOOD HEALTH
MA12-04574OtherUNITED HEALTHCARE
MAE02029Medicare UPIN