MEDICARE: DR. SUSAN HARRIET BLACK MD

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	207SG0201X	Clinical Genetics (M.D.) Physician	0101039820	VA

General Provider Information

NPI Number	:	1104851765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HARRIET BLACK MD

Provider Business Mailing Address
First Line	:	PO BOX 418498
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-8498
Country	:	US
Telephone Number	:	703-558-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 IRVING ST NW
Second Line	:	POB #3800 NORTH WASHINGTON HOSPITAL CENTER
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-6093
Fax Number	:	202-877-8695

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/27/2012

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