Provider Demographics
NPI:1093814808
Name:HORN, TODD L (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:L
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 1:56 TOWER CIR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3476
Mailing Address - Country:US
Mailing Address - Phone:606-677-2913
Mailing Address - Fax:606-677-6983
Practice Address - Street 1:56 TOWER CIR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3476
Practice Address - Country:US
Practice Address - Phone:606-677-2913
Practice Address - Fax:606-677-6983
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38031207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64089139Medicaid
KY193400000XOtherTAXONOMY MULTIPLE SINGLE SPECIALTY GROUP
KY64089139Medicaid
KY193400000XOtherTAXONOMY MULTIPLE SINGLE SPECIALTY GROUP
KYH99404Medicare UPIN
KY0585106Medicare PIN