Healthcare Provider Details

I. General information

NPI: 1073545158
Provider Name (Legal Business Name): ARTHUR MACNEILL HORTON EDD MED DPD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SISTER PIERRE DR 403
TOWSON MD
21204
US

IV. Provider business mailing address

120 SISTER PIERRE DR 403
TOWSON MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-6408
  • Fax: 443-279-0537
Mailing address:
  • Phone: 410-823-6408
  • Fax: 443-279-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number01629
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: