Individual
BRUCE CHARLES BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
372 WASHINGTON ST, WELLESLEY, MA 02481-6202
(781) 239-3550
(781) 239-3272
Mailing address
372 WASHINGTON ST, WELLESLEY, MA 02481-6202
(781) 239-3550
(781) 239-3272
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
53793
MA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
53793
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053793
TUFTS HEALTH PLAN
MA
01
—
J04142
BLUE CROSS OF MA
MA
Enumeration date
08/13/2006
Last updated
01/15/2010
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