Healthcare Provider Details

I. General information

NPI: 1922006485
Provider Name (Legal Business Name): WILLIAM R BLACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W HENDERSON ST
SALISBURY NC
28144-2725
US

IV. Provider business mailing address

825 W HENDERSON ST
SALISBURY NC
28144-2725
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-5542
  • Fax: 704-636-5142
Mailing address:
  • Phone: 704-636-5542
  • Fax: 704-636-5142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number19313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: