Provider Demographics
NPI:1043417751
Name:BLACK, ANDREW C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5220 FLANDERS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9112
Mailing Address - Country:US
Mailing Address - Phone:225-766-3437
Mailing Address - Fax:225-766-3443
Practice Address - Street 1:5220 FLANDERS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9112
Practice Address - Country:US
Practice Address - Phone:225-766-3437
Practice Address - Fax:225-766-3443
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93573207W00000X
NC2008-00586207W00000X
LAMD.203115207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology