Individual
HAROLD MICAGAH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 391-3129
(703) 295-9369
Mailing address
PO BOX 37090, BALTIMORE, MD 21297-3090
(703) 295-9360
(703) 295-9369
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024070513
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139180
ANTHEM
VA
05
—
1831198084
—
VA
01
—
298077
AMERIGROUP
VA
01
—
K142-0002
CAREFIRST
DC
Enumeration date
07/19/2005
Last updated
09/09/2008
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