Provider Demographics
NPI:1104851765
Name:BLACK, SUSAN HARRIET (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HARRIET
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418498
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8498
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:POB #3800 NORTH WASHINGTON HOSPITAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2975
Practice Address - Country:US
Practice Address - Phone:202-877-6093
Practice Address - Fax:202-877-8695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039820207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)