Provider Demographics
NPI:1114095346
Name:BLACK, JAMES N (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:NEVILLE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 CRAIG LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1902
Mailing Address - Country:US
Mailing Address - Phone:404-550-8748
Mailing Address - Fax:212-202-3705
Practice Address - Street 1:520 CRAIG LN
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1902
Practice Address - Country:US
Practice Address - Phone:404-550-8748
Practice Address - Fax:212-202-3705
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070510L207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
29BDCLQMedicare ID - Type Unspecified
H31814Medicare UPIN