Individual
MR. DAVID L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
4310 LONDONDERRY RD, SUITE 202, HARRISBURG, PA 17109-5300
(717) 920-7664
(717) 920-4361
Mailing address
1700 S LINCOLN AVE, LEBANON, PA 17042-7529
(717) 272-6621
(717) 228-6156
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA000813L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0993475
KEYSTONE
PA
01
—
50041402
BLUE CROSS
PA
Enumeration date
09/09/2005
Last updated
02/19/2020
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