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NPI Code Detail

MEDICARE: MRS. GLORIA GILBERT BLACK CRNA

MEDICARE: MRS. GLORIA GILBERT BLACK CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician0024076529VA
2367500000XCertified Registered Nurse Anesthetist0024076529VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2296621OTHERVAAMERIGROUP
3K142-0002OTHERVACAREFIRST
4139180OTHERVAANTHEM

General Provider Information

NPI Number : 1003815267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GLORIA GILBERT BLACK CRNA
Provider Business Mailing Address
First Line : PO BOX 37090
Second Line :
City : BALTIMORE
State : MD
Zip : 21297-3090
Country : US
Telephone Number : 703-295-9360
Fax Number : 703-295-9369
Provider Business Practice Location Address
First Line : 3600 JOSEPH SIEWICK DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-1709
Country : US
Telephone Number : 703-295-9360
Fax Number : 703-295-9369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 02/21/2019

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Directions to “ MRS. GLORIA GILBERT BLACK CRNA” Practice Location

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