Provider Demographics
NPI:1346460698
Name:BLACK, CAROLINE DELCETA (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:DELCETA
Last Name:BLACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13116 ARDENNES AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-2332
Mailing Address - Country:US
Mailing Address - Phone:301-540-1886
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CENTER ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-295-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-05-23
Deactivation Date:2023-05-04
Deactivation Code:
Reactivation Date:2023-05-23
Provider Licenses
StateLicense IDTaxonomies
MD17660171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider