Individual
MR. CARL BLACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1216 E HUNTING PARK AVE, PHILADELPHIA, PA 19124-4928
(215) 533-1333
(215) 744-4324
Mailing address
1216 E HUNTING PARK AVE, PHILADELPHIA, PA 19124-4928
(215) 533-1333
(215) 744-4324
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OA005627
PA
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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