Provider Demographics
NPI:1336253293
Name:HORN, FRANK W (MD)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:W
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 1:1001 EAST SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-9762
Mailing Address - Country:US
Mailing Address - Phone:814-274-7407
Mailing Address - Fax:814-274-0807
Practice Address - Street 1:1001 EAST SECOND STREET
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9762
Practice Address - Country:US
Practice Address - Phone:814-274-8750
Practice Address - Fax:814-274-7970
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016695E208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006975490001Medicaid
PA98225OtherBLUE SHIELD
PA02308000OtherBLUE CROSS
PA02308000OtherBLUE CROSS
PA095429JT3Medicare PIN