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General NPI Number Information
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NPI Number | 1265529788
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Entity Type | Individual
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Provider Name | NANCY BURGESS BLACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CREDENTIALS COORDINATORS WALTER REED ARMY MEDICAL CTR ATTN MCHL MAO C 6900 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-3321
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Fax |
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Provider Business Mailing Address
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Address Line | CREDENTIALS COORDINATORS WALTER REED ARMY MEDICAL CTR ATTN MCHL MAOC 6900 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-3321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD 8257
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License Number State | HI
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