Individual
COREY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13700 ST FRANCIS BLVD STE 100, MIDLOTHIAN, VA 23114-3222
(804) 594-7300
(804) 594-7410
Mailing address
13710 ST FRANCIS BLVD STE 100, MIDLOTHIAN, VA 23114-3267
(804) 594-7300
(804) 594-7410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101271663
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101271663
STATE LICENSE
VA
Enumeration date
05/31/2006
Last updated
11/27/2024
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