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NPI Code Detail

MEDICARE: DR. KRISTIN SHANNON BLACK MD

MEDICARE: DR. KRISTIN SHANNON 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
1207Q00000XFamily Medicine Physician9901115NC
2207Q00000XFamily Medicine Physician22582SC

Other Identifiers

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

General Provider Information

NPI Number : 1609872720
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN SHANNON BLACK MD
Provider Business Mailing Address
First Line : 820 W MEETING ST
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2202
Country : US
Telephone Number : 803-285-5441
Fax Number : 803-285-7509
Provider Business Practice Location Address
First Line : 820 W MEETING ST
Second Line :
City : LANCASTER
State : SC
Zip : 29720-2202
Country : US
Telephone Number : 803-285-5441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 09/26/2012

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Directions to “ DR. KRISTIN SHANNON BLACK MD” Practice Location

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