Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD451803 | PA |
NPI | 1003951872 |
---|---|
Provider Name | David Lloyd Black |
First Address | Rockland, DE 19732-0191 |
Second Address | Wayne, PA 19087-4043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 07/01/2016 |