Healthcare Provider Details

I. General information

NPI: 1073508958
Provider Name (Legal Business Name): JUDITH S BLACK M.D.,M.H.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 FRIENDSHIP AVE STE 200
PITTSBURGH PA
15224-1778
US

IV. Provider business mailing address

352 HUNT RD
PITTSBURGH PA
15238-2228
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-5810
  • Fax:
Mailing address:
  • Phone: 412-963-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD 016868E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: