# THOMAS BLACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1508838871
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 232292 | NY | — |
| 208000000X | Pediatrics Physician | 86636 | SC | Yes |

## Other

- **Enumeration date:** 02/02/2006
- **Last updated:** 10/10/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00026910201 | UNIVERA HEALTHCARE | NY |
| 01 | — | 00026910202 | UNIVERA | — |
| 01 | — | 000527733001 | BLUE CROSS BLUE SHIELD | NY |
| 01 | — | 000527733002 | BC/BS | — |
| 05 | — | 02577360 | — | NY |
| 01 | — | 070804000017 | FIDELIS | — |
| 01 | — | 1212594 | IHA | — |