Healthcare Provider Details

I. General information

NPI: 1396700613
Provider Name (Legal Business Name): MARCUS L. BLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 METAIRIE RD
METAIRIE LA
70005-4311
US

IV. Provider business mailing address

3600 PRYTANIA ST STE 35
NEW ORLEANS LA
70115-3628
US

V. Phone/Fax

Practice location:
  • Phone: 504-324-9024
  • Fax: 504-373-6807
Mailing address:
  • Phone: 504-897-8315
  • Fax: 504-891-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number05701R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: