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1033102520

NPI Code Detail

MEDICARE: PAUL W. HORCHOS D.O.

MEDICARE: PAUL W. HORCHOS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	OS009683L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00121395	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	902508	OTHER	PA	BLUE CARE
3	21992-1067	OTHER	PA	GEISINGER
5	2159434	OTHER	PA	AETNA
6	20012325	OTHER	PA	AMERIHEALTH
7	50075034	OTHER	PA	CAPITAL BLUE CROSS
8	804445	OTHER	PA	BLUE CARE HMO (FPH)

General Provider Information

NPI Number	:	1033102520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL W. HORCHOS D.O.

Provider Business Mailing Address
First Line	:	5 MORGAN HWY
Second Line	:	SUITE 4
City	:	SCRANTON
State	:	PA
Zip	:	18508-2641
Country	:	US
Telephone Number	:	570-344-3788
Fax Number	:	570-969-9280

Provider Business Practice Location Address
First Line	:	5 MORGAN HWY
Second Line	:	SUITE 4
City	:	SCRANTON
State	:	PA
Zip	:	18508-2641
Country	:	US
Telephone Number	:	570-344-3788
Fax Number	:	570-969-9280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	06/17/2009

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1528051091 — KENNETH W. GENTILEZZA M.D.
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1477546968 — ELIZABETH KARAZIM-HORCHOS D.O.
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Practice Fax: 570-969-9280

1053304519 — MICHAEL D. WOLK M.D.
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Practice Fax: 570-969-9280

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SCRANTON, PA
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1598759086 — MRS. CHARLENE ANN MARSICO CRNP
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Directions to “ PAUL W. HORCHOS D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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