Individual
MR. ANDREW P BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA - C
Contact information
Practice address
6438 WILMINGTON PIKE STE 110, DAYTON, OH 45459-7021
(937) 848-4121
(937) 848-5965
Mailing address
6438 WILMINGTON PIKE STE 110, DAYTON, OH 45459-7021
(937) 848-4121
(937) 848-5965
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50-002937
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000636013
BCBS-OH
OH
Enumeration date
10/27/2009
Last updated
03/26/2018
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