Provider Demographics
NPI:1033129721
Name:HORST, PAMELA SUE (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:HORST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:PALLIATIVE CARE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-448-5175
Mailing Address - Fax:315-448-3557
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:PALLIATIVE CARE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-448-5175
Practice Address - Fax:315-448-3557
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY137793-1207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832393Medicaid
NYRA5137Medicare PIN
B82338Medicare UPIN