Provider Demographics
NPI:1952387060
Name:HORN, MARTIN S (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:S
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 1:10721 MAIN STREET
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6906
Mailing Address - Country:US
Mailing Address - Phone:703-352-2620
Mailing Address - Fax:703-352-2594
Practice Address - Street 1:10721 MAIN STREET
Practice Address - Street 2:SUITE 3100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6906
Practice Address - Country:US
Practice Address - Phone:703-352-2620
Practice Address - Fax:703-352-2594
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033164207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005949467Medicaid
DC068803Medicare ID - Type UnspecifiedDC/NORTHERN VA/MD
VA005949467Medicaid