Individual
HARRY RICHARD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
659 W ONONDAGA ST, SYRACUSE, NY 13204
(315) 475-5176
(315) 476-0263
Mailing address
659 W ONONDAGA ST, SYRACUSE, NY 13204
(315) 475-5176
(315) 476-0263
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
119574
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018612
GHT
—
01
—
00981
BLUE SHIELD
—
01
—
286833
UNITED HEALTHCARE
—
01
—
321287
MVP
—
Enumeration date
09/16/2006
Last updated
07/08/2007
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