Basic Information
| Provider Information | |||||||||
| NPI: | 1366449365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HORIZON SURGICAL GROUP, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HORIZON VASCULAR SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20410 OBSERVATION DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208766419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017620277 | ||||||||
| FaxNumber: | 3013309108 | ||||||||
| Practice Location | |||||||||
| Address1: | 20410 OBSERVATION DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208766419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017620277 | ||||||||
| FaxNumber: | 3013309108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3013301000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 915011100 | 05 | MD | MEDICAID |