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NPI Code Detail

MEDICARE: HAROLD MICAGAH BLACK CRNA

MEDICARE: HAROLD MICAGAH BLACK CRNA
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
1367500000XCertified Registered Nurse Anesthetist0024070513VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1139180OTHERVAANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3298077OTHERVAAMERIGROUP
4K142-0002OTHERDCCAREFIRST

General Provider Information

NPI Number : 1831198084
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAROLD MICAGAH BLACK CRNA
Provider Business Mailing Address
First Line : PO BOX 37090
Second Line :
City : BALTIMORE
State : MD
Zip : 21297-3090
Country : US
Telephone Number : 703-295-9360
Fax Number : 703-295-9369
Provider Business Practice Location Address
First Line : 3600 JOSEPH SIEWICK DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-1709
Country : US
Telephone Number : 703-391-3129
Fax Number : 703-295-9369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 09/09/2008

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Practice Location Address:
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Directions to “ HAROLD MICAGAH BLACK CRNA” Practice Location

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