MEDICARE: CHRISTINE EDITH KERSHNER HORAH 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	207Q00000X	Family Medicine Physician	C20005526	DE
2	207Q00000X	Family Medicine Physician	H0054380	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00908838	OTHER	DE	MEDICARE RAILROAD PROVIDER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	510410752	OTHER	EMPLOYER IDENT. NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760484018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE EDITH KERSHNER HORAH D.O.

Provider Business Mailing Address
First Line	:	412 SUBURBAN PLZ
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-3564
Country	:	US
Telephone Number	:	302-738-3770
Fax Number	:	302-738-4749

Provider Business Practice Location Address
First Line	:	412 SUBURBAN PLZ
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-3564
Country	:	US
Telephone Number	:	302-738-3770
Fax Number	:	302-738-4749

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/19/2011

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Directions to “ CHRISTINE EDITH KERSHNER HORAH D.O.” Practice Location

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