1912071606 NPI number — DR. ROXOLANA IRENE HORBOWYJ M.D.

Table of content: (NPI 1679613525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912071606 NPI number — DR. ROXOLANA IRENE HORBOWYJ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORBOWYJ
Provider First Name:
ROXOLANA
Provider Middle Name:
IRENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912071606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
617 SOUTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLMES
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19043-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-461-8718
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
BLGD. 10, 4 WEST
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20889-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-295-3899
Provider Business Practice Location Address Fax Number:
301-295-9076
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD052224L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)