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Individual

DR. GLENN RAYMOND BLACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
103 5TH ST SE, STE S, BARBERTON, OH 44203-4256
(330) 753-5863
(330) 753-9838
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
UNITED MINE WORKERS
OH
01
1786246
CIGNA
OH
01
341397094026
CARESOURCE
OH
01
4205812
AETNA
OH
01
59634
QUALCHOICE
OH
01
729783
BUCKEYE COMM HEALTH PLAN
OH
01
791063783
RAILROAD MEDICARE
OH
Enumeration date
12/01/2005
Last updated
04/02/2024
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