Healthcare Provider Details

I. General information

NPI: 1457562670
Provider Name (Legal Business Name): ALISON BLACK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 JOSEPH SIEWICK DR STE 400
FAIRFAX VA
22033-1761
US

IV. Provider business mailing address

3620 JOSEPH SIEWICK DR STE 400
FAIRFAX VA
22033-1761
US

V. Phone/Fax

Practice location:
  • Phone: 703-264-7801
  • Fax:
Mailing address:
  • Phone: 703-264-7801
  • Fax: 703-264-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102203345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: