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General NPI Number Information
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NPI Number | 1427042092
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Entity Type | Individual
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Provider Name | DAVID L BLACK PAC
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 4310 LONDONDERRY RD SUITE 202
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City | HARRISBURG
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State | PA
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Zip | 17109-5300
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Country | US
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Telephone | 717-920-7664
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Fax | 717-920-4361
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Provider Business Mailing Address
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Address Line | 1700 S LINCOLN AVE
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City | LEBANON
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State | PA
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Zip | 17042-7529
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Country | US
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Telephone | 717-272-6621
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Fax | 717-228-6156
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MA000813L
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License Number State | PA
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