Provider Demographics
NPI:1356384424
Name:VANHORN, ALYCIA S (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALYCIA
Middle Name:S
Last Name:VANHORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALYCIA
Other - Middle Name:S
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9103 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3900
Mailing Address - Country:US
Mailing Address - Phone:443-777-8825
Mailing Address - Fax:443-777-8405
Practice Address - Street 1:9103 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3900
Practice Address - Country:US
Practice Address - Phone:443-777-8825
Practice Address - Fax:443-777-8405
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ33304Medicare UPIN
MDKK40L834Medicare PIN