Healthcare Provider Details

I. General information

NPI: 1801225255
Provider Name (Legal Business Name): RITA HUTCHINSON BLACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SANDLAKE COMMONS BLVD STE 220
ORLANDO FL
32819-8011
US

IV. Provider business mailing address

7300 SANDLAKE COMMONS BLVD STE 220
ORLANDO FL
32819-8011
US

V. Phone/Fax

Practice location:
  • Phone: 215-704-7638
  • Fax: 407-248-8909
Mailing address:
  • Phone: 215-704-7638
  • Fax: 407-248-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME95725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: