MEDICARE: DAVID LLOYD BLACK M.D.

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
1	208000000X	Pediatrics Physician	MD451803	PA

General Provider Information

NPI Number	:	1003951872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LLOYD BLACK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:
City	:	ROCKLAND
State	:	DE
Zip	:	19732-0191
Country	:	US
Telephone Number	:	302-651-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 W LANCASTER AVE
Second Line	:	SUITE 200
City	:	WAYNE
State	:	PA
Zip	:	19087-4043
Country	:	US
Telephone Number	:	610-293-2229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	01/07/2016

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