MEDICARE: DR. ROBERT A. 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	207RC0000X	Cardiovascular Disease Physician	ME72600	FL

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

General Provider Information

NPI Number	:	1508826785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A. BLACK MD

Provider Business Mailing Address
First Line	:	646 VIRGINIA ST STE 200
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-6612
Country	:	US
Telephone Number	:	727-724-0425
Fax Number	:	727-724-0425

Provider Business Practice Location Address
First Line	:	646 VIRGINIA ST STE 200
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-6612
Country	:	US
Telephone Number	:	727-724-0425
Fax Number	:	727-724-0425

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/19/2022

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