Healthcare Provider Details

I. General information

NPI: 1477740843
Provider Name (Legal Business Name): RAYMOND L HORWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 ROGUES RIDGE RD.
WINHALL VT
05340
US

IV. Provider business mailing address

PO BOX 516
BONDVILLE VT
05340-0516
US

V. Phone/Fax

Practice location:
  • Phone: 802-297-2910
  • Fax:
Mailing address:
  • Phone: 802-297-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number131768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: