Individual
ANDREW JAMES BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2215 BURDETT AVE., HMP OF SAMARITAN, TROY, NY 12180-2466
(518) 270-3094
(518) 270-3095
Mailing address
2215 BURDETT AVE., HMP OF SAMARITAN, TROY, NY 12180-2466
(518) 270-3094
(518) 270-3095
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
244711
NY
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
036-108517
IL
208M00000X
Hospitalist Physician
Primary
244711
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-108517
—
IL
Enumeration date
06/02/2006
Last updated
05/07/2021
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