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Individual
TINA M BLACK
Active
Individual
TINA M BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34005618
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000380935
ANTHEM BC/BS
OH
05
—
0936116
—
OH
01
—
341542312098
CARESOURCE
OH
01
—
378646
WELLCARE
OH
01
—
740121
BCHP
OH
01
—
P00338796
CARERR
OH
Enumeration date
10/27/2006
Last updated
02/05/2008
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