Healthcare Provider Details

I. General information

NPI: 1033129721
Provider Name (Legal Business Name): PAMELA SUE HORST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE PALLIATIVE CARE
SYRACUSE NY
13203
US

IV. Provider business mailing address

301 PROSPECT AVE PALLIATIVE CARE
SYRACUSE NY
13203
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5175
  • Fax: 315-448-3557
Mailing address:
  • Phone: 315-448-5175
  • Fax: 315-448-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number137793-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number137793-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: