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1093798720

NPI Code Detail

MEDICARE: DR. RICHARD R BLACK DO

MEDICARE: DR. RICHARD R BLACK DO

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	207R00000X	Internal Medicine Physician	34003488	OH
2	207U00000X	Nuclear Medicine Physician	34003488	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	BL4212094	OTHER	OH	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093798720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD R BLACK DO

Provider Business Mailing Address
First Line	:	PO BOX 89
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-0089
Country	:	US
Telephone Number	:	216-245-0203
Fax Number	:	440-893-9680

Provider Business Practice Location Address
First Line	:	28062 BAXTER RD
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-1401
Country	:	US
Telephone Number	:	951-290-4000
Fax Number	:

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	01/27/2023

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Directions to “ DR. RICHARD R BLACK DO” Practice Location

Language	Start Address	Practice Location

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