MEDICARE: RITA HUTCHINSON 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	207R00000X	Internal Medicine Physician	ME95725	FL

General Provider Information

NPI Number	:	1801225255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA HUTCHINSON BLACK M.D.

Provider Business Mailing Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 220
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	215-704-7638
Fax Number	:	407-248-8909

Provider Business Practice Location Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 220
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	215-704-7638
Fax Number	:	407-248-8909

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

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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