Individual
CHARLES GLENN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1231 COLONIAL PARK DR, SEVERN, MD 21144-4417
(410) 570-1446
Mailing address
1231 COLONIAL PARK DR, SEVERN, MD 21144-4417
(410) 570-1446
(410) 721-7580
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
18275
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18GMMA
BCBS OF MARYLAND
—
01
—
5120
GHMSI/BLUECHOICE
—
01
—
701076
ACN
—
Enumeration date
08/15/2006
Last updated
05/26/2009
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