Organization
GLENN R BLACK MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN RAYMOND BLACK MD FACC (MEDICAL DOCTOR)
(330) 753-5863
Entity
Organization
Contact information
Practice address
103 5TH ST SE STE S, BARBERTON, OH 44203-4256
(330) 753-5863
Mailing address
586 MARINA DR, AKRON, OH 44319-3424
(330) 645-6809
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35.036808
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191152
ANTHEM BC BS
OH
01
—
0400075
UNITED HEALTHCARE
OH
05
—
0429549
—
OH
01
—
107535
KAISER
OH
01
—
1263551
UMW
OH
01
—
1786246
CIGNA
OH
01
—
274462003-00
BWC
OH
01
—
274462003005
MEDICAL MUTUAL
OH
01
—
295174
FEDERAL BLACK LUNG
OH
01
—
354693
ADVANTRA
OH
01
—
4205812
AETNA
OH
01
—
59634
QUALCHOICE
OH
01
—
729783
BCHP
OH
01
—
791063783
RAILROAD MEDICARE
OH
01
—
Q014575
HOMETOWN
OH
Enumeration date
05/14/2007
Last updated
03/12/2024
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