Individual
ANGELIQUE V BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1850 TOWN CENTER PARKWAY, SUITE 400, RESTON, VA 20190
(703) 689-0300
(703) 787-9664
Mailing address
11240 WAPLES MILL ROAD, SUITE 403, FAIRFAX, VA 22030
(703) 246-8080
(703) 691-4932
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002122
VA
Other
Enumeration date
07/18/2006
Last updated
07/08/2007
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