MEDICARE: LISA ANTOINETTE HORTON M.D.

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	208000000X	Pediatrics Physician	D31987	MD

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

General Provider Information

NPI Number	:	1427021112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANTOINETTE HORTON M.D.

Provider Business Mailing Address
First Line	:	9426 DARTMOUTH RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1809
Country	:	US
Telephone Number	:	410-740-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	7310 RITCHIE HWY
Second Line	:	SUITE 516
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3065
Country	:	US
Telephone Number	:	410-761-7305
Fax Number	:	410-761-7387

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

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	08/05/2011

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