Provider Demographics
NPI:1881714301
Name:HORNE, GINA V (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:V
Last Name:HORNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E ROYALTON RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3532
Mailing Address - Country:US
Mailing Address - Phone:440-838-8222
Mailing Address - Fax:440-838-8294
Practice Address - Street 1:5901 E ROYALTON RD STE 2200
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3532
Practice Address - Country:US
Practice Address - Phone:440-838-8222
Practice Address - Fax:440-838-8294
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2944792Medicaid
OH4266331OtherMEDICARE ID