Provider Demographics
NPI:1982910717
Name:ROBERT M HORTON MD PA
Entity type:Organization
Organization Name:ROBERT M HORTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-2333
Mailing Address - Street 1:3124 BLUE RIDGE RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8041
Mailing Address - Country:US
Mailing Address - Phone:919-782-2333
Mailing Address - Fax:919-787-5269
Practice Address - Street 1:3124 BLUE RIDGE RD
Practice Address - Street 2:SUITE #101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8041
Practice Address - Country:US
Practice Address - Phone:919-782-2333
Practice Address - Fax:919-787-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19169261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC80945Medicare UPIN