Provider Demographics
NPI:1285039735
Name:BLACK, ROBERT (HCP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BLACK
Suffix:
Gender:M
Credentials:HCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 GAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3456
Mailing Address - Country:US
Mailing Address - Phone:740-353-1021
Mailing Address - Fax:513-433-0129
Practice Address - Street 1:1012 GAY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3456
Practice Address - Country:US
Practice Address - Phone:740-353-1021
Practice Address - Fax:513-433-0129
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1138237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist