Individual
LISA M BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
111 COLCHESTER AVE, UVM MEDICAL CENTER EMERGENCY DEPARTMENT, BURLINGTON, VT 05401-1473
(802) 847-0000
Mailing address
617 RIVERSIDE AVE, BURLINGTON, VT 05401-1601
(802) 864-6309
(802) 860-4313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055.0031258
VT
Other
Enumeration date
06/26/2008
Last updated
04/03/2017
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