Provider Demographics
NPI:1225227481
Name:BLACK, CAROLE BERTOZZI (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE BERTOZZI
Middle Name:
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 1:147 WABAN HILL RD N
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1054
Mailing Address - Country:US
Mailing Address - Phone:617-312-8834
Mailing Address - Fax:
Practice Address - Street 1:NAVIGANT CONSULTING
Practice Address - Street 2:101 E. KENNEDY BLVD., SUITE 2200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602
Practice Address - Country:US
Practice Address - Phone:617-312-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine