Provider Demographics
NPI:1427196096
Name:BLACK, CHARLES ALEXANDER JR
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:BLACK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:ALEXANDER
Other - Last Name:BLACK
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:HS
Mailing Address - Street 1:85 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1098
Mailing Address - Country:US
Mailing Address - Phone:978-827-4384
Mailing Address - Fax:
Practice Address - Street 1:427 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1027
Practice Address - Country:US
Practice Address - Phone:617-223-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other