Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 0101039820 | VA |
NPI | 1104851765 |
---|---|
Provider Name | Dr. Susan Harriet Black |
First Address | Boston, MA 02241-8498 |
Second Address | Washington, DC 20010-2975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 27/02/2012 |