Individual
DR. DALLIAH MASHON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
044471
CT
208600000X
Surgery Physician
223910
MA
208600000X
Surgery Physician
Primary
74430
MN
2086X0206X
Surgical Oncology Physician
43694
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286882001 (MDACC)
—
TX
01
—
468419
TUFTS HEALTH PLAN
MA
01
—
8DB287
BCBS (MDACC)
TX
01
—
J28934
BCBS MA
MA
Enumeration date
10/26/2005
Last updated
09/27/2023
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