Provider Demographics
NPI:1912975525
Name:DRAGHICIU, HORIA (MD)
Entity type:Individual
Prefix:
First Name:HORIA
Middle Name:
Last Name:DRAGHICIU
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8943
Mailing Address - Fax:765-935-8944
Practice Address - Street 1:1050 REID PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-935-8943
Practice Address - Fax:765-935-8944
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055849A207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089342Medicaid
IN000000623480OtherANTHEM PROVIDER NUMBER
IN200365980Medicaid
IN259370011Medicare PIN
IN815500Z8Medicare PIN
IN200365980Medicaid