MEDICARE: MR. RONALD A BLACK 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	207Q00000X	Family Medicine Physician	20695	MT
2	207Q00000X	Family Medicine Physician	MD22584	HI

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912903311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD A BLACK M.D.

Provider Business Mailing Address
First Line	:	449 KAPAHULU AVE STE 104
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-3850
Country	:	US
Telephone Number	:	808-735-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	449 KAPAHULU AVE STE 104
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-3850
Country	:	US
Telephone Number	:	808-735-0007
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	05/31/2023

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Directions to “ MR. RONALD A BLACK M.D.” Practice Location

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