Healthcare Provider Details

I. General information

NPI: 1053488049
Provider Name (Legal Business Name): STEVEN R BLACK MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98A COPE CREEK ROAD
SYLVA NC
28779
US

IV. Provider business mailing address

PO BOX 2286
SYLVA NC
28779-2286
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-7925
  • Fax: 828-586-7926
Mailing address:
  • Phone: 828-586-7925
  • Fax: 828-586-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20050976
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20050976
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN R BLACK
Title or Position: OWNER
Credential: MD
Phone: 828-586-7925