Healthcare Provider Details

I. General information

NPI: 1316254139
Provider Name (Legal Business Name): ASHLEY GALE BLACK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MONROE ST UNIT 308
SYLVANIA OH
43560-2768
US

IV. Provider business mailing address

5700 MONROE ST UNIT 308
SYLVANIA OH
43560-2768
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-7555
  • Fax: 419-479-2696
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.131207
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036131207
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036131207
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34.018351
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number34.018351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: