Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0024076529 | VA |
NPI | 1003815267 |
---|---|
Provider Name | Mrs. Gloria Gilbert Black |
First Address | Baltimore, MD 21297-3090 |
Second Address | Fairfax, VA 22033-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003815267 | (05) | VA |
139180 | ANTHEM (01) | VA |
296621 | AMERIGROUP (01) | VA |
K142-0002 | CAREFIRST (01) | VA |