Healthcare Provider Details

I. General information

NPI: 1447782842
Provider Name (Legal Business Name): ERIN CARROLL BLACK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2725
US

IV. Provider business mailing address

8916 CHERRY ST
BLUE ASH OH
45242-7814
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-5446
  • Fax: 513-686-6868
Mailing address:
  • Phone: 513-283-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58.029802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: