Individual
DR. JASON W BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D61199
MD
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
D61199
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405540300
—
MD
01
—
KJ15/64265301
CAREFIRST MARYLAND GBMC
MD
01
—
S1380079
CAREFIRST REGIONAL GBMC
MD
Enumeration date
07/19/2006
Last updated
12/21/2011
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