Healthcare Provider Details

I. General information

NPI: 1316599020
Provider Name (Legal Business Name): EVAN MICHAEL BLACK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE BETHESDA, MARYLAND 20889 BUILDING 1-3RD FLOOR
FPO AA
20889
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE BETHESDA, MARYLAND 20889 BUILDING 1-3RD FLOOR
FPO AA
20889
US

V. Phone/Fax

Practice location:
  • Phone: 800-526-7101
  • Fax:
Mailing address:
  • Phone: 800-526-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberDS042340
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: