Individual
LAURA CELESTE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
336 N MAIN ST, WEST HARTFORD, CT 06117
(860) 232-4891
(860) 236-1016
Mailing address
17 VIRGINIA AVE, SUITE 107, PROVIDENCE, RI 02905-4406
(401) 443-4992
(401) 784-4902
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD14897
RI
Other
Enumeration date
05/23/2012
Last updated
05/15/2018
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