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General NPI Number Information
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NPI Number | 1326253238
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Entity Type | Organization
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Legal Business Name | GLENN R BLACK MD INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 103 5TH ST SE STE S
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City | BARBERTON
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State | OH
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Zip | 44203-4256
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Country | US
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Telephone | 330-753-5863
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Fax |
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Provider Business Mailing Address
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Address Line | 586 MARINA DR
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City | AKRON
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State | OH
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Zip | 44319-3424
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Country | US
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Telephone | 330-645-6809
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | GLENN RAYMOND BLACK
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Credential | MD FACC
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Telephone | 330-753-5863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35.036808
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License Number State | OH
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