Provider Demographics
NPI:1407881790
Name:HORBACH, NICOLETTE SIGRID (MD)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:SIGRID
Last Name:HORBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:571-389-7140
Mailing Address - Fax:703-992-7584
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6800
Practice Address - Country:US
Practice Address - Phone:571-389-7140
Practice Address - Fax:703-992-7584
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053444207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA618462YPA1OtherMEDICARE ID
VA618462YPA1OtherMEDICARE ID