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General NPI Number Information
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NPI Number | 1134435613
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Entity Type | Organization
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Legal Business Name | DOUGLAS J BLACK MD LLC
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 875 GREENLAND RD SUITE B4
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City | PORTSMOUTH
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State | NH
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Zip | 03801
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Country | US
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Telephone | 603-427-2577
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Fax | 603-427-0048
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Provider Business Mailing Address
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Address Line | 875 GREENLAND RD SUITE B4
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City | PORTSMOUTH
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State | NH
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Zip | 03801
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Country | US
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Telephone | 603-427-2577
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Fax | 603-427-0048
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS J BLACK MD LLC
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Credential | MD
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Telephone | 603-427-2577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 10894
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License Number State | NH
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