Provider Demographics
NPI:1477255115
Name:BLACK, MORGAN D
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:D
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:47809
Mailing Address - Country:US
Mailing Address - Phone:765-592-3707
Mailing Address - Fax:
Practice Address - Street 1:620 CHESTNUT ST.
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:47809
Practice Address - Country:US
Practice Address - Phone:812-237-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program